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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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dMa at sflyem ofr ahcnging my nsar.ew

tyFalu loicg aedm me newrod if itinhtg rouy hade duwlo sceuad sedriecan CPI o,s kile a gihscun ,eulrc uoy uwold teg iaeersncd sguaV renve taciitvy adn mayeb aybdardriac + yiehtnnospo. But I gseus the SARA smeyts loudw ahev ouetecdctran tath nda cduase tcnooaincsvrtois revo 24 horu,s os opevmcilHyo chkos is iiedyentfl the tesb o.ccieh

Aslwya lsdouh go htwi the uvobsoi aernws :)

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seagull  I dha the deai htta tshi wsa a unicernoge ohksc adn snciiagern anaanilrirct rpsseeru ulodc fafcet het vsgua oo.t I hknit eht eoisnutq llryae asntw su ot go atth iot.crdien +17
uslme123  The hnigsCu eelrfx alsde ot idardac!yrba +7
purdude  Wiat mI' ncodesuf. I hthoutg mclheovipoy cohks ealsd ot na dirsecnae ?VSR +2
littletreetrunk  lerptn,ayap 'erseth a intgh alclde syttpacmeih saecpe ttha can anepph efrat a lheiw i.(.e she' ebne otu fro 42 oush:)r nioluucmAact fo estsui amcoltebi rstlavaoido ssecsabutn mairsip cets-tdeyaiieapdhmtm oriocstovst,incna ciwhh seald ot olss fo aauvslcr o,ent grpssevrioe ysieonphont and gnaro fseupop.nyihor +1
littletreetrunk  osal aosl if he thi hsi dahe he lcduo vahe ssol of cptshatmiye toofulw orfm a hiypcxo laduelm hwich cluod elad ot davtiiola,son hiwhc ruetfhr seucder ieralatr ,esersrpu but hits swa a hrda neo fro em ll.o I alos ptu dreainces CPI a.wh +1
catch-22  nyA ackl fo cmsttehyapi /doeiswenafctrluo vaalg wltuofo luhdso eeudrc RH, ont neiaecrs it. urhtrFe, you lowud cxpeet ertnsbaim issng fi eterh saw ohipyax to het tiranmbe.s oFr eplam,xe fi yuo had admage to eth risyltao u,nelsuc you dowutln' eb lbae to egetuarl ruoy RH ni renssoep to ucdeerd .BP eSinc hsit ntpetia sha deucder BP adn eircdsena ,HR htsi itadcnesi atth eht rprimya icrsndeatub si ellkiy teh uddecre Hs PB'e. aols ebne ni a sredet for 2+4 husor so. +5
charcot_bouchard  nI a itntpae woh esoevpld yosntoneihp oollgiwfn nr-eygheigh a,turma coeuirngen hocsk is a soiinadgs of loeunixsc atth si emad farte voyiecoplhm nda obttucivsre iiadogcecrn hscok avhe enbe duler o u!stlPu sbtenA dBaiaydrrca surel it tuo +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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mmHm. elWl my mdni hsa obwnl ffo sabeceu awth tih my nimd saw ridotheadny neics he swa ni teh se.edtr sA onso as ym nmdi eadtrst to aderwn aotbu lla fo het tehor isopnto taht oucld make se..se.n I jstu dicckel dna mdeo!v

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charcot_bouchard  Satmr bio +5
usmlecharserssss  nkiihg in ahasar stdree MSH +4
cbreland  epSilm = rmast +


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 +2  upvote downvote
submitted by diabetes(31)
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elgneidb + uperress donw p+lseu pu uqeal eyhomliocvp khcso

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submitted by nwinkelmann(366)
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I fnuod siht abuto esiadr PCI: tatsniPeenro" fo saredi aciinlaratnr ssuerrpe = ahac,hede amlad,ipeepl siiveno/agt,amnu rowes in het oimnngr as PCI rasies nrdgiu eth gthin as a soeenccqenu fo crbneyomec, a isre in OP2C ugdirn selpe ecadsu yb tiopayrrres orpesdie,ns adn lrabbpoy a deeacser in SCF o,tipbaonrs llpiparyu io,lntdia so,psit iepdiamr zag,e arpyisrtreo lyrugati,rrei S,AM nda enagcsh ni BP, ,RH dna itrpaeosrry eapnttr aer yulluas leta igssn of dsirae CIP and ealtder ot srmeaitbn odstitoirn ro e.sih"miac

j/7/3n:hsb2c3pcttoijp1nn/otsmn.u_pp//t/me.l

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 -1  upvote downvote
submitted by hello(429)
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'tWhsa eht sshcoeyem edpsposu ot be a celu tbauo? Deos stih enptati evah ?CDI eosD DIC swalya uaecs ompyiocvhel hckso?

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drdoom  neitaDeidsms virusclanaatr aoocgniulta )(ICD is a rdyosnicm eifiio.tdnn ee(S tna.getn) It osde ton y“als”wa elad to hoskc ubt shock is fdliyieten a pbiesols eqlaseu sc(,ine yb nfioen,tdii DCI = mistsy“ce otbcmtrhoi ps;r”oecs aniynthg tsmsycei ulsodh tge uoy a etiltl wrdeir,o) dan os a tiatepn tiwh IDC uosdhl eb ornmtdoie cls!yole +
yesa  I khnti heyt add ot the hlymeopaovi uci;pter he si yddtradehe DAN iegeldnb oitn hsi utseiss beasuec fo utsoonisnc ;-t&-g edeescrad avrtrnuaslcai eu.l.mo..v +

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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