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Retired NBME Free 120 Answers

free120/Block 1/Question#31 (reveal difficulty score)
A 16-year-old boy is admitted to the ...
Hemopneumothorax, not under tension ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ / ๐Ÿ“–
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submitted by โˆ—bwdc(697)
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Air and fluid = hydropneumothorax. If that fluid is blood (s/p stabbing), itโ€™s a hemopneumothorax. Lack of mediastinal shift indicates that itโ€™s not under tension.

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d_holles  @benwhite_dotcom how can it not be under tension if air is entering the pleural cavity? +2
nwinkelmann  Because the stab wound isn't functioning like a flap, meaning the air can escape. The reason a tension pneumothorax occurs is because the wound acts as a flap, where on inspiration it is open and air enters, but on expiration is closes and traps the air. +13
groovygrinch  Also if there was tension, there would be a mediastinal shift. +17
t123  Also the gastric bubble is elevated, actually suggesting lower pressure. Mediastinum shifts require more pressure, but the gastric bubble confirms it. +2
myoclonictonicbionic  I was overthinking and thought they're implying that the stomach bubble is the air-food level that was seen on the Xray. +4
cheesetouch  umm air-fluid*^ lol +2
chaosawaits  Can someone please explain the significance of the stomach bubble? +



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