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NBME 21 Answers

nbme21/Block 2/Question#31 (56.6 difficulty score)
A 37-year-old man is brought to the emergency ...
IntercostalπŸ”
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 +10 
submitted by hayayah(1079),
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thWi itsh etons,qui I khnit etyh natw uyo to rgczeieon thta teh itnptae ni'st ghivan cthes nipa dlertae to eth hr.tea Thye eshmapzie aervsle ibr uraetfsrc and a oteoxhranmup ubt otn'd adtnciei yna rthea adgmea kca(l of asnidtteiuvo sndsuo = no omlrpaynu amede dedaiticn ro a gnul essui dtaeelr ot rahte leor.)pbm

The rditiripscea si s'htwa etenrdvain yb eht erincph n. nigeeS as who sih tearh si ,nfei the edarucfrt sbir ear lbaproyb awth era siguacn mhi nipa iav the ettnislcroa envse.r

didelphus  Visceral pain is typically poorly localized (heart attacks are usually described as "crushing pressure" that radiates to the shoulder or neck), so this patients "sharp" right-sided pain in the setting in multiple right-sided rib fractures is likely related to the ribs. The intercostals run with the ribs and provide sensation to the chest wall. +12  



 +10 
submitted by sweetmed(144),
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anPi efbirs for aPtrleia lr:aeup virlCeca nad tColas stpar is by clIsaetnort erNve, mcgpiiaDarhat and dneaiaMtlsi vai irnhceP veNer. Rbi ecag jyunri ucesas taocsl urpella ina.p




 +5 
submitted by vlodkadrinker(7),
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y?wh ilek dose my edm olsohc csku or ma I utsj tath mdbu cuz ew evenr neeadrl atigyhnn ielk iths

sklawpirt  I think its just that the patient is CONSCIOUSLY experiencing chest pain. Because he is consciously feeling the pain and would be able to directly point to it (and that it is not referred visceral pain) it has to be a somatic afferent nerve fiber. This narrows it down exclusively to the intercostal nerve exc;usively. https://en.wikipedia.org/wiki/Intercostal_nerves IMportant to the patients "right sided chest pain" is his history of MVA and x-ray confirming multiple rib fractures. I think this is correct? Does that make sense ? All of the other choices do not carry SA fibers in that area +11  



 +2 
submitted by yssya1992(8),
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ehT eadi ot nowk ist a saciomt inap os in hteor cocehis olyn sit cdluo eb ehirpcn or ttarniolesc nrci ePh usyllua lliw nmtdneoei rtidngaai ot deosrhul ni anioitd wtha nneitmoed above atubo epnhrci rneev eoavnnirint rof pltieaar llueapr




 +1 
submitted by yssya1992(8),
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Teh daie ot nowk sit a actisom pnai os ni rtheo cceoihs oyln tis cluod eb iprcenh or ttilsraceon nePcr hi lyuusal will ntoimneed iintagdra ot selhoudr n i oiindta thwa eedinotmn eoabv tubao hprnice eenrv avieortinnn rfo leptriaa peralul




 +1 
submitted by burak(56),
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sCltao nad viearccl rluaep si nirtevande yb crlotsniae vne,er sleiaianmdt adn atidgpacarhmi relapu si nairendvet by nephicr .nrraetlcoveIenst arvne inpa ypitlacyl tfle eoclsr to het ,anip heircpn nerve )53C(- ipna is tdadaeir ipna yb AURLAPIVRASUCCL renev eara s) hrUeuod(w.l stoneuqi D:I 5351