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NBME 21 Answers

nbme21/Block 3/Question#2 (36.8 difficulty score)
A 40-year-old man with interstitial pulmonary ...
Increased radial traction on airwaysπŸ”

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submitted by benzjonez(45),
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wrdUol dQi 1543 sha a gdoo oanlxnaptei sa ot who lnpmuoayr isirobfs aicesnrse teh alaidr atintocr no teh aywiar lwal.s

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(294),
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nI seac nyaoen si a edens sa I ma adn just di'tnd erdematnunedsr/mebr tahw cetlaxy patxeyriro lfwo si = EVF1. In tcviisteerr ioidnsct,no FVE1 si mornal ro ricesndae due to addcseere CFV. neisttItrlia isbsoifr = inecadesr iraywa pnearyacmh lfdfaosc naduor teh ,saiyrwa hcihw si htwa spevrdio alraid ittr.caon Teh rregate hte dairal toi,crnat hte reowl het clgsailonp ,ocerf adn so aroxtipery owfl is nea.srcied

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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orluyPanm sirfisbo lliw nvoelvi ginlutaraon eusist s(a ti is sorsib).fi uatrnGanoli siuste uldecins ,rfsblooytmbsai chwih llwi "l"lpu no eht yrai,saw erbthye icerasgnin ldarai icnat.tro

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

radial traction emphysema vs fibrosis

+1/- alexv0815(-1),