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Retired NBME 23 Answers

nbme23/Block 2/Question#7 (reveal difficulty score)
A 45-year-old man is brought to the emergency ...
Hypovolemic shock 🔍 / 📺 / 🌳 / 📖
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submitted by sympathetikey(1600)
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Mda at yfmesl rfo ngganhic ym se.wrna

yFtula logci aedm me enodwr fi gtiihnt yruo dhea lwoud dasuec esraeincd IPC os, ielk a hsgucni uel,rc uyo luwdo egt diercnesa gVaus evenr aviytcit nda abmey irdaaybracd + nhientoosy.p utB I ugses hte RASA etysms wdluo heav aurdneecottc htta dna usaced snotrisitvacocno evro 42 suho,r so lomyvceHpio ohksc is idletnefiy eth btse occ.hie

waAysl lsuohd go tihw het souibvo enwars ):

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seagull  I hda eht eadi tath isth wsa a ninceogreu skcho dan snrniceagi ctaaainnlirr rpesresu cdluo cfefta teh gausv .oot I tkhin teh etiqonsu layrle atswn us to og that droie.cnit +17
uslme123  Teh hinsCug eflrxe adsel to air!cdbydara +7
purdude  itaW 'mI .fdcesuon I guhthot eplyvomhoic hkocs selad to na ecdseiarn VS?R +2
littletreetrunk  aynltpr,eap hs'eetr a ignht llcdea ehatyispmct ascepe htta nca hapenp eftra a hwlie i.(.e e'sh bene tou rfo 24 )ruo:hs mtacuuclnAoi fo uistse ietoblcam vdaoltrisao csbenuasts pairmis ym-thctpdetiiaeasmed rsaovnnsi,coiottc ichwh aseld ot loss of ulvarasc o,ten epgvrssiroe nyotshinpoe and angor nrpoo.hpeisyfu +1
littletreetrunk  aslo also if eh thi ish dhea he dclou aevh sosl fo msepcthitay ultwofo rofm a yhcxiop lamelud hciwh dlouc dlae to laod,asvintoi ihcwh erurhtf uecsrde eirarlat ssurpe,er utb htis wsa a drah noe orf em ll.o I oasl upt sancierde IPC hwa. +1
catch-22  nAy ckal of thaspciytem tewf/dulracisoeno agalv utloofw sluhdo ceuedr RH, not acnisere .ti hurtreF, uyo wodlu ecptex aeistrbnm ngiss if tehre wsa oyiahxp to het rtemabi.ns For em,laepx if yuo dha aegmda ot eht sytrolai elsucu,n ouy owld'utn be bael to tleeruag uyro RH ni repnsoes ot dcdueer B.P ecniS siht aepttin ash cdueerd PB and rieeancds HR, isht icntsiade htta eth amirpyr trcaudsibne is leylki het reeucdd s .P'BHe sloa eben ni a etrdes orf +24 roush .so +5
charcot_bouchard  In a etanitp how vlesdpeo tpnseooinhy gooniwlfl yn-ihhregeg mtraua, cernegunio kcsoh si a nsaigiods of xeioclsun atht si aedm rafte ovhpmeilocy and svotrubecit noagcciried kshoc aevh ebne drlue lsuo !utP bteAns yridaBcdaar sleru ti tou +2

Increased ICP would present with the cushing reflex (hypertension, bradycardia, irregular respirations). This occurs because during increased ICP, the brain will compress cerebral arteries causing reduced cerebral perfusion. As we all know, cerebral perfusion pressure = MAP - ICP, and thus the body will force a pressor reflex to raise the MAP to try to keep the brain perfused.

Unfortunately, this causes reflexive bradycardia due to the baroceptor reflex activating. The irregular respirations are because the brainstem is compressed.

Since our patient does NOT have the classic cushing triad, you can rule out increased ICP.

+17/- drzed(333)

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 +4  upvote downvote
submitted by yex(128)
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Hm.mm Well ym dinm ash oblnw off bsuaece tawh tih ym dnim wsa nihtreddoya nisec eh saw ni eht .rtdese sA noso as my mdin dsreatt to wnared touba all fo the toerh ntoiops that docul kmae sn...ees I stju kelicdc dan em!vdo

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charcot_bouchard  mtaSr oib +5
usmlecharserssss  hignik in aaashr edtrse SHM +4
cbreland  eSimlp = tsarm +


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 +2  upvote downvote
submitted by diabetes(31)
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bdeiengl + psrseeru ndow e+pslu up aqelu iheocyvmolp skohc

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submitted by nwinkelmann(366)
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I ufdno siht botau adersi PIC: "ensoiPneratt fo saredi inarrtaacnil pseursre = hecea,had pelel,madapi auvigoienn/,satm weors ni eht nnirmog sa CPI aeisrs dungir the ihtgn sa a qnecuesoenc fo ,ebmycncreo a eisr ni OP2C dgrinu slepe seaucd by roeptyaisrr ,irpodnsees adn poraylbb a eearceds ni FSC niop,osratb liyralppu doa,iinlt itoss,p pimeirda ,zeag rapoeryrsti rriiugtr,laye ,AMS nad gsehcna ni PB, ,HR and pyrtaesorri prtatne rae yaulslu aetl sgnis fo idsrea CIP nad tadelre ot bemastinr ontrtdiois or .emhsiaic"

ub:t/min2c/_tt/n33j1pste.shn/popl./nm/cj7op

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submitted by hello(429)
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taWsh' hte hecoeysms osspeudp to be a lceu ?uabto oDse tsih tantpei hvea ?IDC Deos CDI walasy sceua yhoipoecmvl kohs?c

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drdoom  isDetsidnaem navciralrtusa uoaglcaoitn (ID)C is a rocydimns fiioi.nntde eSe( ntnaegt.) It sode not l“aw”say elda ot shkco btu ckosh si nydeilefit a iseplosb euqesal ice,ns( yb done,fiinit CID = ysismcet“ ioctorbhmt oe”rpss;c tiganyhn mscteiys odluhs teg yuo a tetlli ,roeiw)dr dna so a ttipean wtih CID dlhuos eb rmtnioedo !lyesclo +
yesa  I tihkn htye add ot eth moviephloay ;rtuceip he is dreyhaetdd NAD ilenedgb inot ish steussi ceuabes fo ntssoociun -&tg;- edecedras riastnualarvc olu..e.vm. +

From https://meshb.nlm.nih.gov/record/ui?ui=D004211:

Disseminated intravascular coagulation. A disorder characterized by procoagulant substances entering the general circulation causing a systemic thrombotic process. The activation of the clotting mechanism may arise from any of a number of disorders. A majority of the patients manifest skin lesions, sometimes leading to PURPURA FULMINANS.

+/- drdoom(1206)

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