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NBME 22 Answers

nbme22/Block 1/Question#41 (41.0 difficulty score)
A 21-year-old man is brought to the emergency ...
Gender and body habitus🔍

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submitted by drdoom(874),
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oYu avhe ot tiknh tbaou this ngisu teh npectoc fo CDITNNAIOLO TBYIP.IRAOLB tArheon wya to sak tshi pety fo ntoquesi is ilek h:sti “I hsow yuo a patniet whit pesoausnont amrhexpn.outo Wihch rteoh ightn si stom ykiell to eb etur otaub ahtt nsore”p? Or you nac pheras it sehte wsya:

  • Ginev a TICDNIONO (nusnesoapot nepumo,) athw htreo ngfdiin is toms yeillk ot eb het es?ac
  • eGvni a pool of oeplpe hiwt nsonastoepu xamruethop,on hawt otrhe tinhg si omst yelkil to be eurt oatub hetm?

In toerh sodrw, fo lal eeolpp hwo ned pu wiht ostonsuepna onumpe, eth tsmo oncmmo roteh ngith batuo hmte is atth hyte are MAEL ;map& H.NTI

If I vaeg uyo a cekbtu fo poeonnasstu oempnu asittpne -- dan ouy erdchea ruoy danh ni three nad pdlleu one out -- tawh ieracsno wuold be mreo omm:ocn In ryou dhan you evah a soekrm or in your hdan you ehva a niht e?mla tIs’ eth t.rtlae

someduck3  Is this the best approach to all of the "strongest predisposing risk factor" type questions? +  
drdoom  There is a town of 1,000 men. Nine hundred of them work as lawyers. The other 100 are engineers. Tom is from this town. He rides his bike to work. In his free time, he likes solving math puzzles. He built his own computer. What is Tom's occupation most likely to be? Answer: Tom is most likely to be a lawyer! Don't let assumptions distract you from the overwhelming force of sheer probability! "Given that Tom is from this town, his most likely occupation (from the available data) = lawyer." +4  
drdoom  There is a town of 1,000 spontaneous pneumo patients. Six hundred are tall, thin and male. The other 400 are something else. Two hundred of the 1,000 smoke cigarettes. The other 800 do not. What risk factor is most strongly associated with spontaneous pneumo? (Answer: Not being a smoker! ... because out of 1,000 people, the most common trait is NOT smoking [800 members].) +4  
impostersyndromel1000  this is WILD! thanks guy +3  
belleng  beautiful! also, i think about odds ratio vs. relative risk...odds ratio is retrospective of case-control studies to find risk factor or exposure that correlates with grater ratio of disease. relative risk is an estimation of incidence in the future when looking at different cohort studies. +  
drdoom  @impostersyndrome I love me some probability and statistics. Glad my rant was useful :P +  
hyperfukus  @drdoom i hate it which is why your rant was extremely useful lol i learned a ton thanks dr.doom! +1  
dubywow  I caught he was thin. The only reason I didn't pick Gender and body habitus is because he was not overly tall (5'10"). I talked myself out of it because I thought the body habitus was too "normal" because he was not both thin AND tall. Got to keep telling myself to not think too hard on these. Thanks for the explanation. +1  
taediggity  It isn't just that this person has Ehlers Danlos and they're more prone to spontaneous pneumo??? +1  

submitted by drdoom(874),
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fI I geva yuo a ectubk of ponatnesosu upmoen niasetpt -- nda uyo ahdcere ryuo nhad in erhet nda uellpd one uto -- whta acoernsi wloud eb meor moco:nm In rouy nahd uyo evah a rmkeos or in uory adhn you eavh a niht emla? sI’t the ltetra.

submitted by seagull(1539),
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hyW ponesa?nsuot seH' iengngag in na cavtei rspto htwi na iaednscer sirk of Tatumcira nryi.uj oS ew elayrl jtus mssuae esh ton nujirde escbuea het tmes nstoed ritlyced asy hes' e?ijrund ehseT otsqinsue elad ot too ynma sapsuistno.m n(i my no)pnoii

nc1992  Spontaneous pneumothorax, as a condition, is significantly more likely than a traumatic pneumothorax from just about anything but a car crash (ok maybe if he was in a fight). The car crash or a stabbing is also more probable overall but there's no point in inferring something that isn't provided +1  
nwinkelmann  I picked the traumatic injury also. After reading these comments I looked into it further. Traumatic pneumos occur because of blunt or penetrating chest trauma, and I found that the MCC form of blunt trauma (>70%) is motor vehicle acidents that cause significant trauma (i.e. rib fractures) or even blast trauma. Although it didn't say there were no chest wall fractures, at the same time it didn't indicate any rib fractures, which would be most like to cause the traumatic injury pneumo in the patient's case. +1  
drdoom  The stem makes no mention of trauma. +  
hyperfukus  i guess the issue is that you have to assume what they mean by "strongest predisposing risk factor for this patient's condition" I think this is dumb bc the answer is completely different based on what you consider this patient's "CONDITION" to be? either way he has a pneumothorax so if you wan to know what caused that its prob him being active or bumping into someone but if you consider the etiology of the pneumothorax then its the bleb and that is from him being a skinny dude/smoker i went to this b/c he's also only 5/10 that's not tall in my head they could have been nicer and made him 6'1 at least...also i feel like i saw a lot of q's back in the day when i first learned this with a presentation of the person like tripping or something dumb but they already had the bleb and then got the pneumothorax +  

submitted by cocoxaurus(56),
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teurRup of mupnloyar bsleb ear a cmonom euacs fo sannetoosup uotehpxmaonr in ygnou altud alsem thta are llat nad tihn. I wokn 'tis aols coeadtsasi twhi ,gikmnos btu engedr dan odby ahuitsb medees kiel eht rmeo llyeki anresw rehe sniec teh patneti si a ungoy .leam

submitted by nwinkelmann(292),
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rHese' omse oipdlimyeoeg iiarmntonfo about usptnoesoan :nsmpoue Trehe rae wto nidsk, raiprym oapntnssoue opnesum (P)PS nda ranecdsyo (.)SPS PSPs ucocr in oepepl gdae 0-023 a,ryse with a akpe ndiccenie si ni hte eyrla ,20s si yarelr ordbvsee in pepole odelr hatn 04 ,eyrsa twih a amel ot mefael iatro fo .1:2,6 dna smto rueyqltnfe rucsoc ni ,ltal tnhi em,n ohutgh skomngi irsenesac iskr eevn hrftreu. PSsS ocurc in nstaipte wiht nduynrelgi nglu isoin,ocndt ushc sa rOd/CeDPol in.ptates fI the satipen't ioerpcdmgah wsa rodle dan dha ytshiro of gunl s,sdaiee tbu that s'wtan na npioo,t tenh I tkinh sikonmg lwodu eb the ppoeprairta coihce uceesba somikgn si eht bitsgeg irks ctfoar rof dleurningy lgun inosnoi.dtc

Rnredgiag het r,uatam icatrmtau iunrjy unospme otsm coomlmyn rucoc ude ot mroot lchieve dcsaneti wereh erthe is nrijyu (.ei. rf)aertuc to hstce awl,l dna twih lsabt iunrs.jie lohhgAtu het oisntueq dd'nti esfyicp het tcseh awll aws oidv of c,arrsufte it osla 'tindd ays curfratse ewre eert,nps so I kithn it dluwo be esfa ot seasum hatt het lsiloncoi nyruji dd'nit haev noehug eocrf ot saceu the ,pomeun ecpsieylal twih inekgep in mdin hte pmeldoygiei fo irarymp aotnsespoun ne.spmou

tA sel,ta sith si my othutgh proscse ihvang reecdeshar ti r,moe n.ow

submitted by hello(311),
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entatPi sha a eahoitrhmx + RCX shwos hracaet astdevie rdwasot hte iorehmhtax &g-t-; ostm lekyli gdnsiaios is oeassonnupt omhnxuaoptre.

lgipolcolamEyidei, spnsoaoeunt poaomnuehxtr si ostm scdiaaesot iwth tinh lsema

hello  Wait, maybe this is wrong logic? Please correct me regarding the exam findings if needed. +  
hello  Can confirm that this explanation is INCORRECT regarding trachea. Disregard this explanation. +  

submitted by its_raining_jimbos(22),
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heyrwEeerv I uodfn D(ptaeoTU nda lsveaer psprae) isad hte nkgsiom is hte begitsg srki artocf rfo seoopustann mxhutornoa,ep itwh dybo uisthab dan energd bngie a lersse .iskr Am I utsj tloeceplym gnddtsiesnamurin eht nustio?eq

imresident2020  Yes smoking is a risk factor but not the best option among the choices given. Check FA, it says that it occurs more in tall thin young males. Smoking isn’t even mentioned. Tall & thin males are more at risk because they have more negative intrapleural pressure. Check Uworld for this. +  
drdoom  You have to think about this using the concept of CONDITIONAL PROBABILITY. Another way to ask this type of question is like this: “I show you a patient with spontaneous pneumothorax. Which other thing is most likely to be true about this patient?” Said a different way: Given a CONDITION [spontaneous pneumo], what other finding is most likely to be the case? Still other words: Given a pool of people with spontaneous pneumothorax, what other thing is most likely to be true about them? In other words, of all people who end up with spontaneous pneumo, the most common other thing about them is that they are MALE & THIN. If I gave you a bucket of spontaneous pneumo patients -- and you reached your hand in there and pulled one out -- what scenario would be more common: In your hand you have a smoker or in your hand you have a thin male? The latter. +  
cocoxaurus  Rupture of pulmonary blebs are a common cause of spontaneous pneumothorax in young adult males that are tall and thin. I know it's also associated with smoking, but gender and body habitus seemed like the more likely answer here since the patient is a young male. +1