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NBME 24 Answers

nbme24/Block 3/Question#16 (41.9 difficulty score)
An 18-year-old woman is brought to the ...
Respiratory acidosis🔍

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 +9  upvote downvote
submitted by keycompany(268),
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shTi tnaetip sha a a.pneothomxur opailHtyivnlentre is ont oeghun to mstcneapeo rfo het avlrelo dcsreeae ni glun esaucfr a.are

_yeetmasterflex  Could the pneumothorax also cause less ventilation due to decreased lung surface, retaining more CO2 causing respiratory acidosis? That's how I got to the answer at least. +3  
duat98  I think pneumothorax would increase RR because you're probably hypoxic. Also I'm sure when you have a lung collapse on you you'd be scared and that would trigger your sympathetic so your RR will go up either way. +3  
kateinwonderland  Arterial blood gas studies may show respiratory alkalosis caused by a decrease in CO2 as a result of tachypnea but later hypoxemia, hypercapnia, and acidosis. The patient's SaO2 levels may decrease at first, but typically return to normal within 24 hours. ( +1  
linwanrun1357  How about choice C, --ARDS? +1  
bullshitusmle  there is no bilateral lung opacities as you would see in ARDS +3  
jesusisking  Was thinking some sort of infection b/c of the atelectasis so picked empyema but this makes sense! +  

 +3  upvote downvote
submitted by jucapami(6),

x-ray corresponds to a tension pneumothorax = imminent respiratory failure if untreated. Right lung is fully collapsed, increasing intra-thoracic pressure, imparing O2 exchange (due to mass effect toward left lung, and collapsed right one), hence accumulating CO2 (in blood), inducing respiratory acidosis.