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Retired NBME 21 Answers

nbme21/Block 4/Question#22 (reveal difficulty score)
A 57-year-old woman is brought to the ...
Ninth ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ / ๐Ÿ“–
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 +8  upvote downvote
submitted by โˆ—burak(71)
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Pleural space: Midcavicular line: 6-8th ribs Midaxillary line: 8-10th ribs Paravertebral line: 10-12nd ribs

So physician must insert a needle in 8-10th ribs in midaxillary line; but insertion below the 9th rib still has a risk to damage abdominal organs such as liver. Upper border of 9th rib is fine.

Uw question ID: 844

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et-tu-bromocriptine  Visual aid that may seem familiar: https://imgur.com/a/JRrN8XH +17
burak  thanks! +
madojo  Make sure you don't do a midclavicular or mid axillary thoracentesis on the LEFT like me or else you'll hit the spleen.... +3
pwaddlecakes  @madojo bet you'll never get a question like this one wrong ever +
kayla  Could anyone elaborate a little on how the insertion points would change if the person was lying down ( instead of sitting upright as stated in the q). thanks so much +



 +1  upvote downvote
submitted by lizard(12)
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Inserting the needle into the 9th intercostal space, midaxillary line during expiration will avoid the inferior border of the lung.

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lizard  Midclavicular line--> 7th intercostal space Paravertebral --> 10th intercostal space. +7



 +0  upvote downvote
submitted by saureus(1)
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https://images.app.goo.gl/PKyrfPDUoeQHYvf26

This image explains it nicely

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