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NBME 21 Answers

nbme21/Block 1/Question#5 (49.2 difficulty score)
A 45-year-old woman is brought to the ...
Absorption atelectasis🔍

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submitted by nosancuck(85),
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rhuB tel me tlle ouy a ill tseecr

EPPE ntvepser Alitsctesae AKA tda GLNU OCPEALSL

nDto be riyorwn uoatb rdamon sordw yhte tspu in trfon fo the IHHG LDEIY nseo

hungrybox  literally LOL'd lmao I love this +13  

submitted by chandlerbas(95),
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hsnborcu ionbrustcot tasp r exnyog in eliolav on egntroin bela ot neetr irmstohecap( rai reetgnin odby 87%( nnrgtioe dan 12% xynge,o rengotin is os apmoitrnt nnigotre bc it si a yroopl obaebrsd sag and uhts is in agehdrc of ekeipng aelvilo tyoifa)ndgexnel ni het velailo is dbrsaobe tion the dgcbdi oernluo het loevum of teh vaoelaeor lilavl aslolecp abonrotsip eaalseicstt

bethune  Why is pulmonary hypertension incorrect? +  
samsam3711  PEEP allows the alveoli to remain slightly open with exhalation to prevent atelectasis. Pulmonary Hypertension is going to be related to vascular changes (instead you might see shunting of blood in areas of poor ventilation) +1  
drzed  Pulmonary HTN occurs because of pulmonary vessel vasoconstriction. This can occur d/t multiple factors, but one of the most important ones is hypoxic vasoconstriction that the lungs will undergo (for example, at altitude). In the setting of PEEP, you are ventilating the lungs perfectly; this allows for the pulmonary vessels to open up and not undergo vasoconstriction. Thus, you prevent pulmonary hypertension via hypoxia. +  
peridot  @drzed by your logic, you're arguing for D to be the answer but the correct answer was about preventing atelectasis +  
medstudent  The question is what’s key. The purpose of PEEP is to keep the airway open. The purpose of ventilation with supplemental oxygen can help with preventing pulm HTN. Could be wrong, but that’s what makes sense to me. +  

submitted by haliburton(208),
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paieiiwdk (p)eglioaso: The trhposmeea si mpesoodc fo %87 ntgeoinr and %12 ngeyox. necSi eygoxn is neecaxhdg at teh -lireyalaoivlcpal ,rbenmeam nrengtio si a oarmj mnoptnoce orf the e'laiovls estta of If a rlgae mleovu fo rignoent in eht uglsn si aprecled ihtw n,eyxog the oynexg amy tuuesnseqbly eb srdebaob tion het dbloo, gdnuerci eth emouvl of teh ilea,olv nerligtsu ni a ofmr of rallaeov loelpacs owknn as obrnspiato aa.ceiesltst

I ohsce driiaeccong e,aemd tub I lieeevb hits is riotrncce aecsbue rteeh is on ehtra raiulfe rski ta hist ,emit os teh uspoepr of hte PEPE si caelitnyr not ot hpsu uot idfu.l

bighead478  doesn't there have to be an airway obstruction (mucus, foreign object etc.) in order for this to happen? 100% O2 without any airway obstruction should not cause absorption atelectasis, right? +  
iloveallpotatoes  And Tension Pneumothorax is wrong bc PEEP would furthur exacerbate that. +1  
hyperfukus  @iloveallpotatoes yea i realized that now after getting it wrong :( +  
plzhelp123  @bighead478, they are using a cuffed endotracheal tube and mechanically ventilating this patient which is creating an iatrogenic "obstruction" and as @haliburton mentioned, having a high FiO2 leads to over-absorption by the blood which leads to absorption atelectasis if no other gas is allowed to enter/there is no communication with atmospheric pressure during expiration. Thus, we add positive end-expiratory pressure which keeps alveoli open at the end of expiration to prevent collapse +