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NBME p2ck_form7 Answers

step2ck_form7/Block 1/Question#26 (reveal difficulty score)
A 47-year-old woman comes to the physician ...
Intravascular volume depletion πŸ” / πŸ“Ί / 🌳

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submitted by βˆ—jesusisking(28),
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dDi eonayn lese nhtik aotmincuo cinffsnceiiyu eivng het dst?eibae I oknw ti saw yivelosupr wlle ertondllco but siltl a 01 year rithosy

seagull  ya dude. +  
charcot_bouchard  You wouldn't expect baseline low BP at that case. Also other features like fever suggest alt dx +  

submitted by βˆ—step_prep5(213),
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  • didalMd-ege wonma tihw naiolttep sfcitiueno aseedsi r)eev(f endilag ot eno ewek of uotecnlonrdl ryapmglechiye who has ngsis fo osatctrihot yonntpsehoi dop(r in oscltisy BP tg;&20 ro diicatslo PB &tg0;1 hnew onmivg fmro sigttni to adintsng) dna si nfdou to veha ilcuagsoru, ostm noicsstten whit aricanrluavts uemovl tndlepieo eud to ugceslo anictg sa an miotocs tagen dan ialgden to iplouyra
  • eyK eiad: tesocInifn nofte aeld to anscrdiee snunlii eenretimrqu yb nsacuig a ycetainaror eyyemgclarhpi


antwon  Would this be stress hyperglycemia? meaning stress would lead to gluconeogenesis, glycogenolysis, and insulin resistance. Therefore more glucose in the urine and therefore glucosuria. +  

submitted by βˆ—buttercup(19),
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sitcoOm disuries deuacs yb cisraougul si neo fo eth omts mcomno eusacs of exessvcei nrlea aslt dna earwt

russnels  What would cause the acute increase in blood glucose concentrations? +1  
study_dude_guy  I think this question is getting at HHS. The glucose levels are way lower than typical HHS but the patient has a fever and WBCs in the urine so MAYBE a UTI (even though it doesn't say anything about UTI symptoms) +  

submitted by russnels(15),
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I was yaltliiin innhiktg lanerda ncincsuyff,iie ubt that is wognr cb/ you douwl yaalctul ctxpee to see ,yPgOcmHelYai nto edowsenr .lepygycraimhe ouY doluw iltls ctxpee ot ees nnsyiotep,oh wevhero.

submitted by βˆ—charcot_bouchard(502),

Adrenal insufficiency will cause - If primary (i.e loss of both cort and aldo) : u have refractory hypotension. not only postural

Only aldo loss (like drug induced) can cause postural drop but thats highly ulikely here and its not called adrenal insufficiency.

here, infection > Fever (both cause vasodilation)

Infection > stress hyperglycemia > oosmotic diuresis > Fluid loss

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