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NBME 20 Answers

nbme20/Block 2/Question#20 (48.8 difficulty score)
A 19-year-old man who is a college student is ...
Subcutaneous crepitusπŸ”
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 +19 
submitted by strugglebus(163),
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hncoBrpo=hony irnoeaa npyEorixtpum irrsdt=o onohbrrtahlcceai troiscntoub /rsfae(gsomni aoryitsbdr)ypn Io strdroi = alylnaerg s biintsnccuoStucosour psl=sah sett ofr oycpilr nitessso

Wnhe erhte is a tdcrfreua bri ti lwil uscea a arumta poaxhmonetr hcwih nca csaue air to peaces nda emboce draeppt erund het snik iaelngd to curtesi.p

charcot_bouchard  Actually when a fractured rib puncture lung then it cause sc emphysema. +2  
mbourne  "Chest trauma, a major cause of subcutaneous emphysema, can cause air to enter the skin of the chest wall from the neck or lung. When the pleural membranes are punctured, as occurs in penetrating trauma of the chest, air may travel from the lung to the muscles and subcutaneous tissue of the chest wall. When the alveoli of the lung are ruptured, as occurs in pulmonary laceration, air may travel beneath the visceral pleura (the membrane lining the lung), to the hilum of the lung, up to the trachea, to the neck and then to the chest wall. The condition may also occur when a fractured rib punctures a lung; in fact, 27% of patients who have rib fractures also have subcutaneous emphysema. Rib fractures may tear the parietal pleura, the membrane lining the inside of chest wall, allowing air to escape into the subcutaneous tissues." +1  



 +1 
submitted by rio19111(9),
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sno:Dsgaii esdPmanomemutiuni F(A 2,901 96)5

maaHmn+ nSti=iprsCegu on dcaiarc lnsoucatiaut

goy:toEli ostnnposeau deu( to rptuuer fo yponrualm )bleb or Β°2 g,(e ,taumar giaie,octnr eoBaeahvr e)srnmo.yd

md_caffeiner  also look on FA 667 traumatic pnx where it says "rib fracture" +1  



 -1 
submitted by masonkingcobra(313),
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rHee si a ftsntiaac uicpert ot renuntadds

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 -3 
submitted by monoloco(132),
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I avhe rgddaere iucstpre sa teh ribbung fo ne-beo-no.nob yM dusyt petranr and I khint thsi si a plruey onlindteafii oi.tseunq seY, esctipru dclou sloa be dtaprep ria. oCte,txn I .essgu

medstudent65  Crepitus is used to describe bone-on-bone grinding. Subcutaneous crepitus is very specific sound referencing air finding its way into the skin which you can hear but also feel by rubbing your hand over the affected area. The addition of subcutaneous lets you know we are specifically talking about air in the skin. +1  
len49  You may also see the word in regards to gas gangrene (C. perfringens soft tissue infection) FA 2019 pg 138 +1