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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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 +4  upvote downvote
submitted by sympathetikey(1600)
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Mad at syfeml ofr inggnahc ym wea.srn

ytaFlu gocil emda me ndwreo fi htgtiin oruy dahe dluow usdaec neiescrda CPI ,os ikle a ichusgn u,ercl ouy lowud tge dcrnaiees uVgas rneev tctvyiia adn mayeb rcyaibaaddr + n.oysehnotip uBt I gsuse eht AARS tesmsy lwoud vahe tdcneotearcu taht adn eucsda icnvnitoaosostcr reov 42 r,uosh so cilpeyvoomH cskho si tifdlneeyi the btes ciohe.c

ayslAw louhds og hitw eht booivus sanrwe ):

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seagull  I had eth daei thta ihts was a eeriongnuc csokh dna nsireangic iilrcanantar spereurs ocdul fectfa het gvuas too. I tikhn hte ostueqin ayllre tsawn su to og ttah ic.otndrie +17
uslme123  The hCugisn eefxrl esald to radci!yrbaad +7
purdude  tWai 'mI ncu.oedsf I thogtuh ivlmocepyoh hskco lesad ot an eadicsner ?SVR +2
littletreetrunk  et,yaprnpla t'ehrse a gihnt eclald ysimhttacep asecep hatt nac pnpeha farte a hleiw .(i.e 'seh bnee tou rof 42 so:uhr) moncAtlcuaiu fo iestsu beamtocil otoaivsdlra ssctsnbaue isimapr teeamditsdhpmcetay-i ciosicnotaotr,vns hcwhi ldsea ot sosl of ucaarsvl t,one iveergrsspo ysenhiontop dna onarg .yfiunprohpeos +1
littletreetrunk  sola losa fi he iht ish adeh he lcodu evha ssol fo ethycpmista lutfoow rfmo a pichyox uamldle whihc ldocu dlae ot v,itnsdooaila which trfhrue rdscuee rtaelria prsse,reu btu itsh swa a darh neo rof em oll. I olsa utp adciesenr PIC hwa. +1
catch-22  ynA lkac fo yemitscahtp ocieroufld/tnaews vlgaa utwfloo luhdos ruedce ,HR ton eneicsar ti. huFrr,et uyo udwol pextec aitsbmrne ssnig if rheet asw aphyoxi ot the smbrn.teia For meaxple, if uyo ahd aeadmg ot eth aiyosrtl suleucn, you uo'dtlnw be laeb ot eglutare rouy RH ni nessrepo to rddcuee .PB cSein this tnatpie sah cdrueed BP adn crseaiend RH, tish diciensta ahtt eht rimprya udbtecranis is liykel eth rddcuee ' HPsB.e lsao eenb ni a dreste ofr 2+4 orhsu so. +5
charcot_bouchard  In a nitepat how pesvleod nhotpiesony lwnfogoli -ghrygnieeh u,aarmt rcnungeieo okshc si a ignasdsoi of uoxcniesl that is emad rfate lihyovompce dan cbtutrvsoei cdrainicoge ckohs vaeh eben rudle out!Psul Atsenb daiadBrracy luesr it uot +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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Hmmm. Well my idmn ash onblw ffo ubceaes what hti ym inmd aws ndhyetrdaio sneic eh saw ni het dsert.e As sono sa my imdn arstdte to wanerd tubao lla of teh ethro iospnto hatt dcoul kaem ess..ne. I just ckcidel nda ovm!de

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charcot_bouchard  martS obi +5
usmlecharserssss  hgniik ni aahrsa stdree MHS +4
cbreland  mlSepi = rstma +


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 +2  upvote downvote
submitted by diabetes(31)
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lbendige + prresuse down spelu+ up eaqlu ilpeovoymhc hkcos

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 +0  upvote downvote
submitted by nwinkelmann(366)
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I ndouf thsi utoab sridea :IPC tetnen"airPos fo sriaed trianrcaailn seuerrps = hedaeahc, epmlelada,ip iisvmnueatogn/a, wores ni eht nrimogn sa IPC ierass rigdnu teh htign sa a eneccqensuo fo bmeyn,ceorc a ersi ni 2CPO idungr eplse udceas yb eptirayrsro sepsieod,rn nad blraobyp a secreade in FSC bapson,iotr pilrylapu olidt,ian ,sstpio emaiirpd agz,e treyrasirpo rierut,graily ,ASM dna ahcesng in P,B H,R adn erirprosaty ttpanre era lasuuly aetl gnsis fo erdasi ICP adn ldrteea ot nesbiarmt sotdtoirin or iie.hcs"am

emj1/t7psjuc./t//:p/nnohp_lnpi3ncts23/mtob.

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 -1  upvote downvote
submitted by hello(429)
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Was'th het heeyscsom sdpoesup to eb a eulc to?aub seoD isth atipnte vhea ICD? Deso IDC awysal saecu vloipmochye co?skh

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drdoom  stndDiesieam lnarsituraavc iclotanaguo D)C(I si a roiyndcsm nniiitfo.ed e(Se get)na.tn tI odse otn l”w“yasa dlea ot oksch ubt ckosh is nifdtyiele a eoblssip aqeleus s(enic, by eotfndni,ii DIC = “cmtyeiss coribthmot roep;css” anhytngi emscysit ldoshu etg uoy a ttllie )r,wodier and so a atpteni whti DIC duohls be edrimtono !ocsllye +
yesa  I hitkn yeht add ot eth yvhealoomip itcurpe; eh si atdyheredd DAN ngeibedl tnio ish ssueits eacbsue of cniotsnous t-g;-& aecesddre lnuvcaatsirra .emuv.o.l. +

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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