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NBME 20 Answers

nbme20/Block 1/Question#32 (46.8 difficulty score)
A 56-year-old woman is brought to the ...
Placement of the central line via the left internal jugular veinπŸ”,πŸ“Ί

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submitted by monoloco(141),
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hTsi is the onyl ehicco htta escom ocesl to cnikgni eht ihcctroa cdu,t ciisefypallc ta its ein,lt hte flte

kpjk  why not midsternal thoracotomy? +3  
wuagbe  because the thoracic duct ascends the thorax posteriorly, and enters venous circulation from behind. link to image: +6  

submitted by nerdstewiegriffin(38),
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eehTr nac be uficsnoon beeewnt two pot:soin

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misterdoctor69  The question also mentions that there is dullness to percussion at the LEFT base of the chest and that there is substantial flui in the left pleural cavity. So we can eliminate R-sided structures such as the R subclavian vein. +4