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NBME 20 Answers

nbme20/Block 2/Question#10 (34.5 difficulty score)
A 70-year-old woman is transferred to a ...
Activity level before the fractureπŸ”
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 +6 
submitted by monoloco(132),
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sTih is ilrceidnty gsinak toaub akpe oneb dtsieny. tTah lhowe thing taobu ahtnrigeiwgbe- icxsesee,r tnigae htgr,i adya ya,ad febeor dan gruidn ttha en-olwpsod aepsh fo elfi rof oneb dneis.yt llA tabou ciunrdge htta 1% erp eyar tegdaeal-er oenb sdnyite ossl as sebt sa ew an.c lLeev fo tvaciity is iryceplse elki ghanwierbt-egi .rcexeise (eCin:dors no tiicat,vy rdbnied-ed -- yas degooyb ot oruy eons;b lghyih v,taiec ursn yevre toreh yad -- godo tumona fo iwgigtaeerbh-n / srstes to enudic mdorgienle nda miainnta neigirtty fo eht .n)osbe

sympathetikey  Yeah, I was thinking about that while taking the exam. Just got thrown off because I don't see how that matters, now that they've fractured the femur. How do prior increases in bone density allow for better chances of bone healing? +13  
rsp  I think that bone density is important here, but think about all of the other things that go in to recovering from a fracture at that age too. How strong are the muscle that will stabilize you while going through the motions of physical therapy? How conditioned are you? +2  



 +2 
submitted by sherry(28),
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iTsh is hte oscnde tebs ccheoi I was ngoan aekt gunrid eht xae.m I htghout geA was ttebre cisen FA decdiitna deasecder eeosnrgt dan ldo eag aer eth nsoresa orf oneb re.trnopois nCa ydeomosb anlxeip ot em hwy gAe cluod tno siypobsl eb eht ewsnr?a

kard  I solve it like this: So age is 70 (already, nothing we can do to change it), is asking about a predictor of success in the Rehab process (So basically, what this patient did in matter of activity, life style, etc. to have a Good rehab process). So From all the answers the, Activity level is the most likely choice because of the, increase in Bone density(Specially Weigh bearing) and OsteoBlastic activity. +6  
misterdoctor69  But bu that logic: just like you can't do anything about age, you also can't do anything about activity level BEFORE the fracture right...? +3  



 +1 
submitted by coconut(3),

NCBI Resource : "Successful interventions concern patients able to walk with or without help before the fracture. Pre-fracture motor and not cognitive level is the most important predictive factor for motor recovery."

https://www.ncbi.nlm.nih.gov/pubmed/17682794




 +0 
submitted by stepwarrior(20),

I don't think you're going to find any evidence for this one. It's just the test-writers' opinion