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NBME 21 Answers

nbme21/Block 3/Question#2 (37.1 difficulty score)
A 40-year-old man with interstitial pulmonary ...
Increased radial traction on airwaysπŸ”,πŸ“Ί

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submitted by benzjonez(45),
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roUdlw Qdi 5314 has a godo oaltnenxaip sa ot owh plnormuya srbfsioi assicnree teh ialdar aottcnri no the awiray

cienfuegos  I think this is it -pulmonary fibrosis increases elastic recoiland widens airway 2/2 increased outward force (radial traction) by fibrotic tissue thus decreasing airflow resistance thus supernormal expiratory flow rates (higher than nl following correction for lung volume) +3  
notyasupreme  ^ Why do I feel like this is literally not english, I have no clue what's being said here. Can someone else explain it? +1  

submitted by nwinkelmann(295),
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nI scea noeany si a denes as I am dna juts ddit'n rrneesemdaburednm/t tawh clxatey xirotpayre owlf is = VE.1F In esriirvctet dcsioitn,no 1VEF si nlamor or sdearince due to ereascdde VC.F Iisnteratilt srsfibio = sdeiaernc awyair yrnpaacmhe sdlcaoff anurdo the waysi,ra wihch si twah dopveisr liarda a.nticrot ehT errtgae hte drliaa inorat,tc eth rewol the napglliosc r,cofe and so orpirayxte ofwl si eicraensd.

champagnesupernova3  FEV1 is increased due to greater recoil of the lung tissue. FEV1/FVC is increased bc of that and bc of decrease in FVC +  
mangotango  But I thought with restrictive diseases, the FEV1 dec a little and FVC decreases a lot, yielding an FEV1/FVC ratio that's normal or increased?? +1  
an_improved_me  Yea the OP is wrong here. FEV1 does NOT equal expiratory flow rate. FEV1 is not a really a rate; its a volume of air pushed out in 1 second specifically. This will be decreased in a pt with ILD. This is because the volume of the lung decreases (due to increased elastic recoil). Expiratory flow rate (in this question) will be elevated, b/c of the answer stated. From uworld: "[fibrosis] causes increased lung elastic recoil, as well as airway widening due to increased outward pulling (radial traction) by surrounding fibrotic tissue. The resulting decrease in airway resistance leads to supernormal expiratory flow rates (higher than nromal when corrected for lung volume)". +  

submitted by visualninjacontender(17),
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amnlyrPuo sirfsobi lwil eivlonv logianarutn istsue (as ti is )osbis.irf iulnorGnaat seitus unesdcli ,ssoabybmiortlf chhiw will up""ll no eth ysraiwa, trhyeeb sciganneri arilda

sahusema  The fibrosis causes contraction, the airways are pulled open giving less resistance to airflow +1

radial traction emphysema vs fibrosis

+1/- alexv0815(-1),