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NBME 22 Answers

nbme22/Block 1/Question#31 (reveal difficulty score)
A 60-year-old woman comes to the physician ...
Lung cancer πŸ” / πŸ“Ί / 🌳
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 +14 
submitted by βˆ—famylife(102),
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eorri/-olinan/rtvbstahyhlamefttnaempncroeube/tmw/etvo-r/oe./s:


 +5 
submitted by βˆ—atstillisafraud(214),
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Weitgh loss - kinht rincr ncaymHaeotape - SIDHA frmo smlla clel unlg ncd aceraEme + JDV - VSC ymdsonre

peridot  I was thinking lung cancer secreting SIADH, resulting in hyponatremia. But because the question asked specifically about the cause of the facial edema, I put hyponatremia (answer choice C). I was wondering how you guys were able to differentiate between C. hyponatremia and E. lung cancer? Thank you! +2  
mannan  The first thing that crossed my mind was SVC syndrome from the cancer obstructing the R brachiocephalic vein preventing venous blood from returning to the heart (and staying in the facial area). Also I assume Hyponatremia would be equivalent to decreased body volume so there wouldn't be edema. FA Renal physiology section has a good chart on what happens during electrolyte imbalances (hypo and hyper) +2  
mannan  @peridot +2  
peridot  I was thinking that hyponatremia would be more loss of osmotic pressure --> edema, but I definitely see the argument for a mass that's simply blocking blood flow. Thank you! +1  
jaramaiha  only thing affecting osmotic pressure is albumin, which would be more towards liver cirrhosis. The body will attempt to maintain a Na+ of 140 with various mechanisms, but doesn't contribute to osmotic pressure. +1  



 +5 
submitted by βˆ—thirdaid(10),
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eTh niiiatl isrptneanote soklo elik ca:nrce tegiwh ssol nda vpreersosgi epysdan vreo hte cerosu of hosntm ni a heyva emskro. Tehn, the tiesuqno rdescseib mytr-paruneoxla otmspmys dna a ppcatsiaonerla nmry.seod

eoMr e,uyltca reeth si epledtvmeon fo deame of teh feca nad jlguaur vusoen iennstdtio. Bsaeuec hsti si elazildoc ot puerp doyb, ew hlsduo nihkt fo a ihceamlnac ouocbtinstr to vensou flow sa pdooesp ot smeo dicargeinco earn.os siTh si na tnpm-xarloeyaru msmtoyp fo gnlu n.racce

[ pSerouir neaV vaCa nermdySo esaudc by het lemaid spadrngie of eth m.ortu Can be cteeebdaxra ni eth haycslpi exam yb ngiska aetpint ot eisra bhto .srma ]

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[ Sroyenmd fo orpeiranptIpa DHA ude( to slalm lcle c,oacnmrai a reoredunencnio trmuo fo the lu)ng eacedsrse moudsi c.ntironoeantc itocrpesPnaala .nmyserdo ]

In yhthePkaStc: SCV reydnoms is teh red obnallo nrea teh imusanmidet hpis and AHDSI is eht ygu gyrint ot arcyr het tarew lrooce nad tenigtg ewrat lla voer hl.seifm

makinallkindzofgainz  I agree! Superior sulcus tumors is a lung carcinoma that occurs in the apex of the lung and can cause SVC syndrome. +2  



 +0 
submitted by βˆ—agraham416(3),
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am i the noyl dubm oen woh ugohhtt ti wsa aedgianoem escua of hte ECA hnioiti?br latolty dglceneet lla erhot an.rtmofniio




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