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NBME 20 Answers

nbme20/Block 2/Question#20 (51.2 difficulty score)
A 19-year-old man who is a college student is ...
Subcutaneous crepitusπŸ”,πŸ“Ί

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submitted by strugglebus(165),
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onhrBho=pnyco rypooEmpanernautx ii rsiodr=t oorebccrthliaahn toncbuosrit eis(sfagrnmo/ tsoyIordai)r ybpn rirtdos = aylaelrgn otouusccstnSiorsnicbu plssha= stte orf ylropic issnoset

ehnW theer is a frtcredua rbi it ilwl seacu a tuamra xempanoroth hhcwi cna uceas ria to pecsea nad obeecm ppertad dnure het nksi ediganl to uieprc.ts

charcot_bouchard  Actually when a fractured rib puncture lung then it cause sc emphysema. +2  
mbourne  "Chest trauma, a major cause of subcutaneous emphysema, can cause air to enter the skin of the chest wall from the neck or lung. When the pleural membranes are punctured, as occurs in penetrating trauma of the chest, air may travel from the lung to the muscles and subcutaneous tissue of the chest wall. When the alveoli of the lung are ruptured, as occurs in pulmonary laceration, air may travel beneath the visceral pleura (the membrane lining the lung), to the hilum of the lung, up to the trachea, to the neck and then to the chest wall. The condition may also occur when a fractured rib punctures a lung; in fact, 27% of patients who have rib fractures also have subcutaneous emphysema. Rib fractures may tear the parietal pleura, the membrane lining the inside of chest wall, allowing air to escape into the subcutaneous tissues." +1  

submitted by rio19111(10),
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iagsis:onD mnnmPeusaomtdueii F(A ,9201 96)5

mHma+na igiS=rnsCtpue on arcdica asutonltuica

lEyoitog: tonasuenops e(ud to uurretp fo mopyanlur l)ebb ro 2Β° (e,g am,utar ,icangietro oBeahreva nd.)eomyrs

md_caffeiner  also look on FA 667 traumatic pnx where it says "rib fracture" +1  

submitted by masonkingcobra(346),
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Hree is a tsactnifa tcpirue to antdruedns


submitted by monoloco(136),
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I heav deegarrd trupcise as teh nbbugri of oo.-nbnbne-eo yM stduy nraptre dan I nkiht iths si a lpyure itenoifdnlai soeiq.tun Y,se ucptiesr luocd sola eb pdtapre ra.i otCe,xtn I sg.esu

medstudent65  Crepitus is used to describe bone-on-bone grinding. Subcutaneous crepitus is very specific sound referencing air finding its way into the skin which you can hear but also feel by rubbing your hand over the affected area. The addition of subcutaneous lets you know we are specifically talking about air in the skin. +1  
len49  You may also see the word in regards to gas gangrene (C. perfringens soft tissue infection) FA 2019 pg 138 +2