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NBME 21 Answers

nbme21/Block 2/Question#31 (54.3 difficulty score)
A 37-year-old man is brought to the emergency ...
IntercostalπŸ”
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 +10 
submitted by hayayah(1056),
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hWti iths tsqinu,eo I kthni hety tnwa oyu ot cizeogrne tath eth ptnaeit tsni' haginv sceth pnai ltarede to teh .rathe heTy pemhzesai ervslea rib ecsrutarf adn a monurpoaexht utb 'otdn iadcietn any ahetr amaegd c(kal fo tvnedtsiauio odnuss = on prayoulnm eamed iecndtaid ro a ngul usise ldratee ot rahet l).poemrb

Teh aetriisridpc si wasth' anvtdniere by eht crhiepn n. eiSgen as ohw shi atreh si ,eifn eht drfreuact sbri rae obpabrly thwa aer sgncaui mhi ianp avi teh tltiroscane e.srevn

didelphus  Visceral pain is typically poorly localized (heart attacks are usually described as "crushing pressure" that radiates to the shoulder or neck), so this patients "sharp" right-sided pain in the setting in multiple right-sided rib fractures is likely related to the ribs. The intercostals run with the ribs and provide sensation to the chest wall. +10  



 +10 
submitted by sweetmed(138),
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iPna fserbi for aaPlerti per:ual Crvleaic nda Cltaos trsap si yb stIenlaroct eNv,re gDchaiiamtrap nda nistilaeaMd aiv hrnceiP Nrvee. iRb caeg ujnriy aecssu asotcl arlepul .anip




 +5 
submitted by vlodkadrinker(7),
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h?wy eilk esod ym emd sholoc ksuc ro ma I sutj thta mdbu czu ew evern dernlea ngtahyin keil tsih

sklawpirt  I think its just that the patient is CONSCIOUSLY experiencing chest pain. Because he is consciously feeling the pain and would be able to directly point to it (and that it is not referred visceral pain) it has to be a somatic afferent nerve fiber. This narrows it down exclusively to the intercostal nerve exc;usively. https://en.wikipedia.org/wiki/Intercostal_nerves IMportant to the patients "right sided chest pain" is his history of MVA and x-ray confirming multiple rib fractures. I think this is correct? Does that make sense ? All of the other choices do not carry SA fibers in that area +11  



 +2 
submitted by yssya1992(8),
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heT eaid to wnok sti a aitmosc inpa so ni eorht hscoeic only its luodc eb ipernhc ro titarneocsl rn cihPe uauslly wlil todennmie igradinta to ldhoseru ni idaitno waht nmenotdei ebaov otabu prheicn eevnr ntneinovrai for aailetrp uleplra




 +1 
submitted by yssya1992(8),
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ehT diae ot nkow tsi a cstmoia napi os ni hoert ciehosc olyn ist luodc eb nicehrp or lortecintsa rniP hec ysullua will mnneedoti nigraatdi to uldeoshr i n odtanii athw ntmidenoe vboea otuab nrcphei eenrv rniivanteno rfo priaaelt rlepual




 +1 
submitted by burak(52),
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olsCat nda ralvceic leaupr is tirdnnaeve yb tsiearclno ve,ren mtnaeiilsda dna pachgatmrdiai lpurae is erdnnetvia by nihcrep .rvIenarsnectloet venra inap tclpyaiyl eflt lerosc to the nai,p hnicrpe vnere )(3C5- pani is idadreat npai by CUPAVULAILACSRR vnree raea Us)eo.hdwrlu( eiunotqs :ID 3515