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NBME 22 Answers

nbme22/Block 4/Question#43 (reveal difficulty score)
A 44-year-old man comes to the physician ...
Tricuspid insufficiency πŸ” / πŸ“Ί / 🌳

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submitted by jointaccount(1),
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"yonl mopiareckhancti ssocpsree ciwhh era cialiglolybo ro ycbemiiohclal tdidaeme vhea hte eatpitonl ot htbxiie feecdinefsr tneebew iracla ro thcein ugo.spr suhT, hte paicoatnecimhkr srcatof hhcwi anc be tceepxde to enitylplato iixbteh alrica feeefndsric ear )1( iaoilbvaiblaity ofr usdrg hhwic drneugo gtu ro ceaithp fpsatirss- bamte,msoil 2)( nertopi ,idgnbni )3( emuolv fo iibdiorsn,tut ()4 hcpiate ,lmmboteasi adn )(5 leran tbulrua scn.treoei nAibstopro ln(uess v),ietac niatrlftio at teh rullsgem,uo nad avispes tuabulr rrboasepitno duwlo ton be tcxdeepe to etibhxi iarlac rsfedc.eeinf "

v:ia b/hu9414cwhig/o.lbp.wem/s3mninn/:2dtv0..wtp

submitted by βˆ—adong(118),
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gto dsfuocen yb teh otscyisl psaloutin fo eth lirve tbu ylslaiacb arggtniteur bdloo mrof VR lwil go oint AR gt&; ICV &;tg iacetph senvi

submitted by βˆ—pppro(25),
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IV gdru bsuea + R aethr uraflie ssmoyptm (dngcoeets )ei:lvr hnkti tdipsucri nfycnieifsicu

fukprometric  why couldn't it be something cirrhosis related given his IVDU? I was thinking that the increased systolic pressure was a sign of portal HTN from cirrhosis so he'd also have a portosystemic shunt, but that was wrong +2  
schep  I picked portosystemic shunt, too. Looking at the question now, I should have focused on the fact that he is IV drug user, has a fever and has signs of right heart failure (back up of blood into the liver) which makes me think endocarditis +1  
jaramaiha  Portal HTN wouldn't give him a fever, but those septic emboli would. TBH to go 10+ years as IVDU w/ no heart conditions, he seems to have played his luck, but luck has run out :( +2  

submitted by medbound57(8),
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rgicancdo to B,;&paBm a laiu"tslep rveli" si a issclac ndginif ni reseev rhgti FH eubcase eht ictspurid roiiggretntau si aedtstntirm to hte .ambendo

ivypoison  Hepatic pulsation is wave from aorta in systolic. Normally (no tricuspid insufficiency), no congestion,no pulsation. In tricuspid insufficiency, ventricular extrasystole (blood from ventricle regurgitate back to vena cava and hepatic vein rather than to lung) + wave from aorta -> hepatic pulsation. Also weak S2 +1  

submitted by βˆ—weirdmed51(26),
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Ayn ehtro niodntisoc rewhe lsnitapuo ni eht lievr nac eb nufod ?

submitted by confidenceinterval(6),
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I aws nwebeet rpitciusd rboelmps ro issorirch ofmr peh .C I tnhik if lal tyhe igev uyo is a dbngoiun lievr og fro teh vvlaural lrpombe ebuasce hoscsirir oudwl eavh rmeo moysstmp ilek iedcesnar gne.tsreo I loas ntkhi the prmoble igneb os cetau sloa nispto ot a ccaradi ag irgd.nRoiine hte ntueiosq g,inaa espmorstyioct nuhst 'nsit os hucm a nsgiidsoa as a el.saquee I lucod eganiim iicduptrs ieinsfuicfycn yetenvlalu inacusg hsu,tn tbu 'tthsa tno ylarel the uriynglend s.ogiainds

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