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Retired NBME Step 2 CK Form 6 Answers

step2ck_form6/Block 2/Question#20 (reveal difficulty score)
A previously healthy 52-year-old man comes to ...
Fluid restriction ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ / ๐Ÿ“–
tags: renal repeat inc

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submitted by โˆ—medicalmike(82)
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This patient with smoking history has euvolemic hyponatremia iso hilar mass, representing SIADH 2/2 SCLC. No signs of AMS so treat conservatively with water restriction. 3% saline is only indicated for symptomatic severe hypoNa.

Hiccups indicate phrenic nerve irritation.

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tinylilron  Are the hiccups related to his SIADH? +
wutuwantbruv  @tinylilron Most likely due to the mass itself as it is in the hilar region and therefore more central and able to compress the phrenic nerve as it passes down through the mediastinum. +
wutuwantbruv  Also as a note, 3% saline is used for severe HYPOvolemic and EUvolemic hyponatremia. NS is used for HYPERvolemic hyponatremia. +1



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submitted by โˆ—step_prep7(71)
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  • Patient with significant smoking history presents with right hilar mass + hyponatremia = SIADH due to small cell lung cancer
  • Note: Hiccups could either be secondary to hyponatremia or could be due to lung mass irritating the diaphragm
  • Mild symptoms of SIADH (sodium >120, lethargy): Fluid restriction +/- salt tablets
  • Severe symptoms of SIADH (sodium <120, seizures, coma): Hypertonic (3%) saline
  • Key idea: Donโ€™t want to correct hyponatremia too quickly in order to avoid osmotic demyelination syndrome (โ€œlow to high, the pons will dieโ€)
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