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NBME Step 2 CK Form 6 Answers

step2ck_form6/Block 1/Question#39 (reveal difficulty score)
A 6-month-old girl is brought to the ...
Patent ductus arteriosus ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ / ๐Ÿ“–
tags: cardio marked

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 +6  upvote downvote
submitted by โˆ—sugaplum(487)

Widened pulse pressure in an adult is regurg. Widened pulse pressure in a new born is PDA. because the blood is swishing back and forth

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jlbae  I literally learned this from Divine last night. Only reason I got this one correct. Why has my medical school failed me so hard? +4
beans123  which divine video?? +
beans123  which divine video?? @jlbae +

 +1  upvote downvote
submitted by โˆ—carolebaskin(109)

PDA gives continuous machine like murmur that crescendos at S2, so loud S2

Agree with sugaplum;

widened pulse pressure => PDA in newborn or regurg in adult

To and fro murmur = wave like = swishing back and forth = PDA

close with indomethacin

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tinylilron  why couldn't it be a Coarctation of the aorta? +1
jlbae  Coarctation would not give a widened pulse pressure. It would present as high BPs in the upper extremities and low BPs in the lower extremities. Also the murmur would be systolic. This "to-and-fro" murmur is synonymous with a continuous โ€œmachine-like", which is present in both systole and diastole. +2

 +0  upvote downvote
submitted by โˆ—step_prep7(71)
  • Leads to a widened pulse pressure (because blood flows from aorta to pulmonary arteries during diastole, leading to reduced systemic diastolic pressure) with a continuous to-and-fro murmur
  • Key idea: PDAs may also predispose to an increased risk of respiratory/lung infections
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