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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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Yuo ehva ot nkiht uotab sthi iguns teh cepotcn fo ATOODNLIICN BBYPILTOAIR. Ahontre ayw to ask iths ptey fo toiqesun is klie hi:st I“ owsh oyu a paeintt itwh pasnstnouoe thxeopoanumr. hcWhi ehort ngtih is sotm kyiell ot be reut butoa taht srop”e?n Or uoy cna ashper ti heest syw:a

  • nviGe a ICNNOITOD (aseonuonpst omupne,) wath toerh dignnfi si otsm eylkil to be teh ?cesa
  • invGe a lopo of leeopp ithw tnsoeanousp pexourntmaho, twah hotre gnith is ostm eillky ot eb rute abtou teh?m

nI ohret sdowr, of lla opeepl hwo edn pu tiwh enauonspsto pem,nou teh osmt coommn ohtre tingh uaobt hmet is taht they ear ALEM ;m&pa .NTIH

If I agve oyu a teubck of nnuosatspoe pueonm itneapst -- and oyu ecdrahe yrou hand in teehr dan uedpll one uot -- htwa aeornisc duwlo eb reom monm:oc In uroy dahn uyo aevh a rkemos ro in rouy anhd uyo aveh a nhit male? t’Is hte

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 gaev ouy a cktebu fo nsooaenuspt eupmno aseitnpt -- and ouy chreeda yoru hadn ni treeh nda pluedl eon otu -- wtha iesoarnc oldwu eb mroe onmcom: In rouy nhda ouy eavh a remkos ro in oyur nhad oyu heva a thni mae?l s’tI eht

submitted by seagull(1539),
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Why nstop?osaune 'Hse iangngge in an ietvac tosrp wtih an redeniasc riks of rmaTaiuct .yrniju So ew yelral stuj ussmea hes not indrjue sebuace teh tesm ntodse idyltrce asy he's ierduj?n ehTse neiosqsut lead ot oto myna mpt.snissaou n(i ym opio)nni

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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eurRutp fo roplymnua belbs rae a oncmmo easuc fo ntsueosoanp utopoxerahmn ni uygon ltuad lmeas that era tlla adn i.tnh I kwon tsi' soal dtacssoeia with mingoks, utb drnege dna ybdo uahitsb mesede liek eht orme leliyk wraesn eher cines the tpitnae is a gnuoy lm.ea

submitted by nwinkelmann(292),
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'sHree eosm mlepygdieoio notromiifan buota epuonatosns sumpn:oe eeTrh era tow skin,d rpayrmi ptsousaenon omuenps S()PP nda eaoycrsnd PS(.S) SPPs rucco in eplpeo dega 0230- ,ersay hitw a epka inncceied si in het lraye ,0s2 si rreayl evbdoser ni eolppe erodl tanh 04 reay,s htiw a elam ot alemfe airot fo :2.16, adn tosm euenrftlyq cscuro in ll,at thin me,n hguhot mgknosi sasiercne ikrs eenv .ferturh PsSS uccor ni teipstna ihtw uegrdnlyin glun idsoontcin, hucs sa ClDdP/Oeor .astetnpi fI eth tetisp'na hodcagmprie saw older and ahd rhyosti fo unlg dssaiee, ubt ahtt 'stnaw na n,otpoi nthe I ktnhi ikongms wuodl be eht aarppptorie coehci esauceb kgisnom is het biegtgs ksir fcotra orf inuegrldny ulng dinoto.snic

dnarggeRi the rtm,aua rtmitcuaa yujnri moensup stom ynmcolmo urcco ued to ortmo hecilev daeisctn ehrwe three is njriyu .(ie. ar)rfucte to teshc wla,l adn htwi sbalt e.jiuirns oAhhgtul het oiqestnu dtnd'i cesfipy teh htcse lwal aws oidv of srt,ufrace ti aols 'didnt ysa ufetasrrc eerw e,pntser os I kihtn it udowl eb fesa ot mauses ahtt the ooislncil jnyuir ddnti' evah ugeonh orefc to aescu het enuo,mp sclelapeyi thiw gpinkee ni ndim eth yidmpeiolge of irpymar uanpnetsoso seponm.u

tA t,lsae ihts is my tgtuohh opsersc gnaivh drrheeecsa it r,oem .now

submitted by hello(311),
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aitPtne sha a mtehraihxo + XCR sswoh aeactrh aeetvisd otraswd hte mrehxhotai &g-;-t tmso ykliel dsigasnoi si snousoeatnp hptmoeoauxrn.

mcdlliygliopoieEa, ostepnuaosn uhorpenmoatx is most aoeasticsd whti inht aseml

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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ryEvewhree I found toD(eTUap nad eevasrl )rppsea isad eth monkigs si the sitgebg kisr ocatfr rof toapsensnou mehnorxtpoa,u thiw bdyo bhtsuia dan generd engbi a eslser kir.s mA I tujs tmlocpeley aiidsdrenmgtunsn teh nqt?sueio

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