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NBME 23 Answers

nbme23/Block 2/Question#42 (reveal difficulty score)
A 63-year-old woman comes to the physician ...
FVC: decreased;
FEV1/FVC: decreased;
Peak expiratory flow rate: decreased;
Peak inspiratory flow rate: decreased πŸ” / πŸ“Ί / 🌳
tags:

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 +21 
submitted by βˆ—seagull(1794),
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yWh si tish nto S?UH woH did yuo gyus hrappcao hte uenis?toq


 +12 
submitted by βˆ—nwinkelmann(349),
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@g9h88 "aeuscBe het tosuicntrbo is aoveb teh lvlroaae rneoisg etrhe si a eacesdre ni rai flwo, not ngul ovumsel, hciwh loudw keam tsih na sutiocrtbve yl"gtpoaoh is eth ostm epulflh .opanxltinea If uoy nkwo teh omts iacsb ooponifnpiitoe/hidytlgysah of rcteivsoutb sv esvceiittrr ihw(hc I ,od sjut n'ddit ni atth tosm siiiplmdef a,wy) nthe ouy can ufergi gnhniaty uo.t fI ohisegtnm is pigimacnt ayiwar ofwl = uroevcitbt,s fi meonhitgs is mintcgaip waariy vlmeuo = ctveirtise.r AHKTN OYU!

burningmoon  How about emphysema? airway volume changed but it's obstructive. +3  
almondbreeze  i think OP meant to say that something DECREASING airway volume = restrictive +3  
jgraham3  I think they mean if something is impacting LUNG volume (ie. expansion/compliance) = restrictive Airway disorder --> obs. / Parenchymal disorder --> res. With emphysema the airway collapses (obs.) before they are able to exhale fully thus the air is trapped +  
dna_at  Just to be clear, this is not a classical obstructive lung disease affecting the small airways, as it is above the carina (trachea). This is better classified as a fixed upper airway obstruction. See the flow loop here for "fixed obstruction" - it came up in IMED UWorld so maybe familiarize yourself with the image since it is unique! https://www.grepmed.com/images/2948 +4  



 +5 
submitted by xkno(5),
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I hooegvtutrh sith neo gbi m.ite ciSne the steunoiq disa the ssam was srnepsig on eth ueotsdi fo the ehcraat, I igudrfe ttha ungrdi ptasirinnoi, bc/ the ctshe sx,peand os more cse,ap os eth ssam dwlou avhe sesl ffctee no the aetcrha sa teh schte xpasnde dn(a eorlny,vsce 'tdi hvae moer fo na ftecfe dnirug roxiniaept sa teh scteh allw cstrr)a.et tn,yapAelrp it was juts atrtihsg up cbealkog nad I hohtgtu aaway to d.har Oops.




 +3 
submitted by βˆ—usmleuser007(444),
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Like ayn fo het ,OCDP het ettniap sah a ufldficit mtie ixeaghnl the periidsn ira (sthu tsi alelcd na rctbsuvieot dsaeei)s

OCDP lsteurs ni CVF adeceesr, FE/1VCFV ratio ,drcaeees CFR rsan,ciee dan peke etopxiyra wofl eesdarec.

A roumt or nya rthoe jtebco taht dwulo esmcpros no or oawrrn etseh het ari awy rtcta owudl sntpree sa a CODP.

aiInnglh adn aglnihxe dwlou eb iilmedt




 +3 
submitted by βˆ—visualninjacontender(17),
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It dlocu eb atth this is a efxdi rpuep yaariw tscrnuoiotb, hhwci dwluo vneptre nfntilaoi nad iodnfaetl fo teh wiasayr eud ot hte utmor glcniamp dnow no teh aecr.tha




 +3 
submitted by βˆ—.ooo. (37),
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I ynsllepoar houtthg fo hsti qeintossu kniginth of it ni ehste t.s.rem enSci teh eiapntt sha a smsa ni het eractha peka epyotxairr nad tiarpnrsoiy fwlo lliw be trrde,pteuin nda woudl ertfrohee eb dasec.ered 1FCV oulwd olas eavh to arecdese by tsih. sThi mietenadli lal het hetro .ihocsce

charcot_bouchard  Are you Me? +3  



 +2 
submitted by βˆ—azibird(227),
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hyW is rhtee a dedscreea VF?C Trhee si a asms sisepnrg no reh eac,arht woh odlcu that sseoiblp efftac ugln eu?vlom fI we gevi rhe uenhgo t,mie hyw cdn'tulo she ktae in a llfu rtah?be




 +1 
submitted by βˆ—mrglass(44),
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I eurgfid htis aws a baialvre itnahcrirtoca toiscoburnt adn ogt it rnw.go

ncdAcoirg ot ,DaUtTpoe uTmRnlilAaIN hlrceaat tbcrontsiou si ,abierlva liweh RaXEnAllTimu cltahrae nrittsocuob (leki ni tihs csa)e si xidef.




 +1 
submitted by docred123(8),
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Hi uygs acn eonmoes lapese eataerlob no thees sign.ifdn I nadsdreunt esh ash nulg cnacer hts'ta idenmipg hre ceaaht.r tuB how is sith atpineevserret of na cirbvuetsot edrs?rdoi tAe'nr gunl acnercs vstcietreir fi nanh?gyti T hsank

nlkrueger  I agree that it's confusing but I looked at it as a physical *obstruction* since it's impinging on the airway.... but yeah idk this is weird +  
ferrero  Doesn't the trachea have cartilage rings so it wouldn't collapse which makes it seem less like a typical obstructive disorder? I'm really not sure why FVC would change because I don't see how total lung capacity or residual volume would change because those are static conditions where there is no airflow at all. I understand FEV1, peak expiratory flow, peak inspiratory flow etc. +2  
mousie  Agree this is a really tough Q but I also think I really over thought it... I eliminated all with a normal Ratio bc something obstructing would obviously produce an obstructive pattern although I don't know why FVC would be decreased. I wasn't sure about both peak expiratory and inspiration flow being decreased can someone help me with this or tell me I'm totally overthinking again.. are they both decreased simply bc theres an obstruction ..? +5  
mimi21  Yea I got confused on this question. But I guess they wanted us to look at it as a obstructive disease . If this were the case all of those function tests would dec. ( See FA ) +  
gh889  Because the obstruction is above the alveolar regions there is a decrease in air flow, not lung volumes, which would make this an obstructive pathology. +3  
charcot_bouchard  FVC here dec same way it dec in Obstructive lung disease. Read the concept of Equal pressure point of BnB. There he says in bronchitis we have onstructive pattern because inflammed airways gen more resistance. so EPP comes early. I guess here due to tracheal narrowing pressure inc downstream. which collapses smaller airway. result in air trapping. +1  



 +0 
submitted by βˆ—donttrustmyanswers(69),
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ottppaoroii"dsner ditruenco in the pake tepriraxoy fowl rate ro mixmaum metnui loevum eacrompd whti het dercfo roiapyertx emoulv ni oen ndeocs VF)1(.E It huolds be ,ntedo ehowv,er htta rehte acn be a nctigniifsa ossl ni wyraai saoi-soternlscc aare eobfre teh exbkotto tlniftgena fo hte oyrinsptiar or oraerpityx oslpo era aivisz.edu"l

n-e%e4dantt:-loc5ce0aotnn/a1i.iu1atcstodrr-helceve#hta_=ta;;l&enna/ly_ept&-pitwnoH9smc&3aisc/2stcmgtedpaatunhe5ip-alnpencboe-ue=Tnnuaactpfawmsrastcyoeaalne;uwm?soipaw=ltslekdt1ly-atg.plr-rm0iisimo~0nuep=7iaart1srcdfauutinstrast=hes_oueadcdab&o8eomc-siogrrt-t7;r-/l

mamed  google fixed upper airway obstruction - the spirometry curve shows decreased inspiration and expiration. A lower airway obstruction just blunts expiration. Extrathoracic blunts inspiration. +1  



 +0 
submitted by ninja3232(11),
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oT kinht abotu shti ypl,mis ti lyletlair is na ctobirtsnou os yuo can utjs ohsoce teh anwers twih hte PODC leik FsP.T

s'tI a tbi euntrcuvoiinteit taht het CVF duolw be adreec,eds ubt het srnoae for tihs is bceaesu ta teh dne rinoaexitp rfo ,VCF the isetiovp leularp erseursp sgiphnu eht ari out hsa lideaeqzu htwi eth usrrpsee of het atehsemopr / riyaaw nwtngia ot epke teh loviale .peno hitW na eiracnse ni the waraiy antsieecrs ofmr eth ourobttsnic, hsti zoiatlnuqaie itonp secmo at a gihher VF.C edoomySb atfc cechk em elpeas




 +0 
submitted by βˆ—agurl1000(5),
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Tihs imtgh eb a arigfwhsratrdto rea,swn but I aws idgwonnre wyh eht tnatipe uodlw haev a dsedracee iapnysrtior lowf? sceBeau ot my rsnd,gnntiuaed oelpep twhi tvtsobrucei sdseaeis ahve rlbtoue eibtrahgn u,to tno i.n. uolCd eemosno xaeinpl to me hyw ti ?saeredsce

rdk3434  okay so i had the same doubt which is why i got this question wrong , but then i had this eureka moment , in uworld there's repetitive images about obstructive and restrictive disease volumes and they always show TRACHEAL STENOSIS along with that , this question is somewhat like tracheal stenosis presentation , just google lung flow volume tracheal stenosis! hope this helps! +1  



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