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NBME 22 Answers

nbme22/Block 1/Question#41 (41.7 difficulty score)
A 21-year-old man is brought to the emergency ...
Gender and body habitus🔍,📺
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 +5 
submitted by drdoom(896),
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ouY evah ot htikn oatbu sthi igsnu teh etpocnc fo INLOTCDNAIO P.BILATIRBYO eornAht wya ot sak this eytp of uqtnoies is ekli st:hi I“ hsow you a epttain wthi snnueoaptso ooanptexmhu.r chWih rtoeh hnitg si toms elyikl ot eb retu tuboa atht n?osr”ep Or yuo acn prehsa ti heets awsy:

  • Gvnei a IIOOTCDNN (pnuenssaoto emopun,) wtha etrho idnnifg si smot lieylk to eb eth sec?a
  • veGni a olpo fo elpepo wtih oatonsnpues eu,hrmopntxoa tawh tehro nihgt si mots yelkil to be rteu utboa t?hem

nI rohte rodws, of lal eopelp owh nde up hiwt ontanspouse ,enompu the tmos omcnmo eroht nigth atobu ehmt is that ethy rae EMLA am;p& HTNI.

If I evag uyo a cbutke fo oanpesunsto peumno iatntsep -- dna you rechdea uoyr nhda in trhee dan lpueld eon tuo -- ahwt cinoarse udowl be orem :ommocn nI ouyr dnah uoy vhae a eomskr ro ni uryo dhan ouy ahve a tnhi ale?m ’Ist het aetl.tr

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].) +5  
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  



 +2 
submitted by drdoom(896),
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fI I egav you a cbtkeu fo neasonutsop pmoune etipsant -- nad ouy adehrce uory dahn ni heter dna puldle eno out -- thaw aciserno oduwl be remo mon:omc In uryo hadn yuo veah a mkrose or ni oryu ndha uoy haev a thin le?am ’sIt eth rt.teal




 +2 
submitted by seagull(1583),
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Wyh anssun?otope 'Hse aggngeni ni an itcvae sropt twih na ncseidare srik fo atmuTcria nurjiy. So ew erylal sutj smuaes she nto eudrinj ebasecu eth tsme sednto rlcyidet say sh'e reujin?d hsTee oetsqinsu ldea to oot myna u.spansoimst in( ym n)ionpio

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 +  



 +1 
submitted by cocoxaurus(55),
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puRuter fo uanpmroyl lesbb ear a mncomo cseua of nostpseouan omapuoxrenht ni young ulatd masel that era llat dan ihnt. I nkwo st'i sloa isecsaotad hiwt ingo,mks utb dregen dan doyb tiushba mdeees keil teh rmoe eliykl wnears eehr scein teh tentiap si a ynugo amel.




 +1 
submitted by nwinkelmann(297),
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Hs'ere seom yoemeiogldip rmiintoonfa uobat toeposnsuna pmonuse: eeThr aer otw snk,di ypiarrm uspnsoeanot soenpmu P)SP( and denacosyr P().SS PPSs ccrou ni epeopl aedg 03-20 sayr,e hwti a peka iiecdecnn si ni hte laery 02s, si laryre erodvbse ni lpoepe lorde ahtn 04 aye,rs ithw a mael ot efaeml ratoi of :,16.2 nad otms ynfeltqure orsucc in ,ltal ihnt ne,m htuhgo gonkmis seensrcia iksr eenv ruehft.r SsSP cuorc ni tasntpie whti rngyulenid ulng noosdi,tcni shuc as lodO/DPCre api.sntte fI eht iaetn'pts rmghieadopc swa leord dan adh ihsoytr fo lugn isae,dse tbu thta w'nsat na ontpoi, enht I hnkti soinmkg oudlw be hte reiptroaapp iccoeh ucbsaee skgonmi si the tsbggie kris croaft rfo lygrdeniun nulg siontcidon.

dgnigRrae hte urtaa,m ucmatatir yruinj pomneus somt lomcymon crouc eud ot morot leivche ciasendt weerh etehr si junriy .(i.e rue)carft ot tches awl,l nda tiwh abtls ersiiuj.n uhlhgtoA teh toeuinsq id'dtn yepifcs the cshte lwla swa idov of ,etfasrcru ti saol d'dnit say atrerscuf reew st,erpne os I inhtk ti loduw be faes to mueass atth eht slcoonili nriyju nd'itd evha hoguen ofrec to useca hte nepoum, lyecpalise wthi piekgen ni dnmi eth lgdoiyeeimp of mryaipr potnauoesns nsmueop.

tA ,lseat hsti si my thhgtou poesrcs haingv rcheesdaer ti ore,m .wno




 +0 
submitted by hello(317),
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Ptteani ash a rohxmieaht + RXC hwsos eraathc iesvdaet doratws hte xhmroaihte gt&-;- ostm elilky odiinsgas si snpooetsnau mropahtonexu.

ielaoiyolcdEgmilp, epnonsstaou arhmexupntoo si mtso cassaoidet hiwt ntih eslma

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. +  



 -1 
submitted by its_raining_jimbos(22),
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eEvheryrwe I fnodu DUtepoT(a nad raevels aerpsp) idsa hte somkgin is hte sgeibtg ksir rfoatc rof psaeonsuont htrnueomo,xap wtih doyb shbutia adn grdene egnib a reelss s.rik Am I jtsu meolytelcp drtminnnudsgesia teh iteu?qnso

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