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NBME 22 Answers

nbme22/Block 1/Question#41 (37.1 difficulty score)
A 21-year-old man is brought to the emergency ...
Gender and body habitus🔍
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 +5 
submitted by drdoom(683),
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ouY veha ot nitkh tbuoa isth gusni het ntoccep fo NOINCTDAOLI AITIR.PYOLBB nAtorhe way ot ksa iths epyt of estouiqn is iekl sh:it “I hosw you a tpenait whit snpusoeanto uxp.tnaoohrme hichW toreh tnihg si somt elliky to be teru ubota that psro”en? rO ouy nca hspear ti ehest w:say

  • vniGe a NOCDITNIO (peosnonuats mnuepo,) awht hroet iinfndg si toms eyilkl to be hte e?csa
  • ivnGe a opol of eploep whti ssaenopuont praehmuonotx, twha eroht tnihg is msot ylleki to be uetr buoat hetm?

nI ehrot sodwr, of lla eolpep owh nde pu whti annupsootse uomn,pe eth mtos cnmmoo eohrt ihgnt obuat mhte si ttha tyeh are AELM ;amp& N.ITH

fI I agve you a ctkebu of snostpenaou menupo tnstaeip -- and you erchdea ruoy ndah in hrete dan lpdeul neo uot -- twha iseoacrn odwlu eb rmoe nomo:cm nI oyur anhd you ehav a remsko or in yuro anhd oyu hvae a htni em?la s’It teh lrt.eta

someduck3  Is this the best approach to all of the "strongest predisposing risk factor" type questions? +  
drdoom  There is a town of 1,000 men. Nine hundred of them work as lawyers. The other 100 are engineers. Tom is from this town. He rides his bike to work. In his free time, he likes solving math puzzles. He built his own computer. What is Tom's occupation most likely to be? Answer: Tom is most likely to be a lawyer! Don't let assumptions distract you from the overwhelming force of sheer probability! "Given that Tom is from this town, his most likely occupation (from the available data) = lawyer." +4  
drdoom  There is a town of 1,000 spontaneous pneumo patients. Six hundred are tall, thin and male. The other 400 are something else. Two hundred of the 1,000 smoke cigarettes. The other 800 do not. What risk factor is most strongly associated with spontaneous pneumo? (Answer: Not being a smoker! ... because out of 1,000 people, the most common trait is NOT smoking [800 members].) +4  
impostersyndromel1000  this is WILD! thanks guy +3  
belleng  beautiful! also, i think about odds ratio vs. relative risk...odds ratio is retrospective of case-control studies to find risk factor or exposure that correlates with grater ratio of disease. relative risk is an estimation of incidence in the future when looking at different cohort studies. +  
drdoom  @impostersyndrome I love me some probability and statistics. Glad my rant was useful :P +  
hyperfukus  @drdoom i hate it which is why your rant was extremely useful lol i learned a ton thanks dr.doom! +1  
dubywow  I caught he was thin. The only reason I didn't pick Gender and body habitus is because he was not overly tall (5'10"). I talked myself out of it because I thought the body habitus was too "normal" because he was not both thin AND tall. Got to keep telling myself to not think too hard on these. Thanks for the explanation. +1  
taediggity  It isn't just that this person has Ehlers Danlos and they're more prone to spontaneous pneumo??? +1  



 +2 
submitted by drdoom(683),
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fI I gave ouy a utecbk fo sonptausone nupeom nittaspe -- nad you hdrceae uoyr hadn ni there nad edlpul neo otu -- thaw csinaoer dwluo eb ermo mmnoco: In uory dhna you evha a mroesk ro ni yruo hdna yuo evha a nhti em?al sI’t hte r.laett




 +2 
submitted by seagull(1171),
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yWh ts?saoneounp 'sHe egngniga ni na citeav ptsor ihwt na creiasdne skir of aiuacrtTm jurniy. oS we layrel sjtu ssueam hes otn jiundre sbucaee eth tsme dsonet eyrtlidc ays hs'e ?nidreuj seheT teoqsnuis aedl ot too namy omspustins.a ni( ym pinooin)

nc1992  Spontaneous pneumothorax, as a condition, is significantly more likely than a traumatic pneumothorax from just about anything but a car crash (ok maybe if he was in a fight). The car crash or a stabbing is also more probable overall but there's no point in inferring something that isn't provided +1  
nwinkelmann  I picked the traumatic injury also. After reading these comments I looked into it further. Traumatic pneumos occur because of blunt or penetrating chest trauma, and I found that the MCC form of blunt trauma (>70%) is motor vehicle acidents that cause significant trauma (i.e. rib fractures) or even blast trauma. Although it didn't say there were no chest wall fractures, at the same time it didn't indicate any rib fractures, which would be most like to cause the traumatic injury pneumo in the patient's case. +1  
drdoom  The stem makes no mention of trauma. +  
hyperfukus  i guess the issue is that you have to assume what they mean by "strongest predisposing risk factor for this patient's condition" I think this is dumb bc the answer is completely different based on what you consider this patient's "CONDITION" to be? either way he has a pneumothorax so if you wan to know what caused that its prob him being active or bumping into someone but if you consider the etiology of the pneumothorax then its the bleb and that is from him being a skinny dude/smoker i went to this b/c he's also only 5/10 that's not tall in my head they could have been nicer and made him 6'1 at least...also i feel like i saw a lot of q's back in the day when i first learned this with a presentation of the person like tripping or something dumb but they already had the bleb and then got the pneumothorax +  



 +1 
submitted by cocoxaurus(52),
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eRrutpu of lmrunpayo elsbb rea a cmmnoo asuce of npasseutoon ohnompuartxe ni unoyg tdalu eslam hatt era ltla dna .ntih I okwn s'it sola iecstasoda ithw ksimg,no tbu dregen nda odyb tsbhaiu esedme leik teh rmeo ykiell rswaen erhe cenis the attiepn is a nyogu .eaml




 +1 
submitted by nwinkelmann(265),
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seerH' emso eoioyelmigpd niaitormfno ubato essnutooapn emops:nu ehreT ear otw in,kds ymapirr useantsopon unpseom ()SPP dan craneyosd .SS)(P PsPS uccro ni pepelo edga 203-0 ery,as hitw a epak eceicndin si in eth lyear ,20s si rrlyea debvsero in loeppe eorld hnta 04 ,eaysr htiw a elma ot ameelf iatro fo :,2.61 adn toms qyetnluerf srocuc in llta, inht me,n hgouht sngiomk riesasnce rsik enve .rhrufet PsSS ccrou in pintesta tiwh lrgdnuynie guln dcoo,snitni scuh as lODPed/Cro tinpae.st fI the i'patsnte hrmgdceaoip wsa lerod nad had isoytrh fo lngu siseea,d btu that 'aswtn an nipoto, tenh I ktihn kgsnimo uowld eb the aptoraripep cihoce ueeacsb giksnom si hte bgitseg iksr oftacr orf idnuglrney lung ncnsoi.iotd

gneairRdg eth atur,ma tuacmtari rjnyui nmoesup osmt mcyolmno crcou ude ot otrmo vicheel iteasdcn reewh ereht is uinyjr ei..( erf)utarc ot hetsc ,lwal nad wthi btlsa jursn.iie ohtAglhu hte utoiqnse itnd'd pecisyf het ehstc llwa saw oidv fo rfescuart, ti oals 'tndid say afertusrc eerw n,eetrsp so I nikth it uldwo eb asef to smeuas htat het inosllcio ynjiur d'dint aevh oeghnu feroc to eascu hte npo,emu elplsaciey hiwt gekipne ni mdni hte dileemioypg fo yparmir nesoptosnua msepu.on

tA atl,se itsh si my htthugo srocesp gnavih rashrdeeec ti erom, wno.




 +0 
submitted by hello(257),
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atinetP has a emrioahhxt + XCR soswh actareh teeiasdv taswodr eth rxetiohmha --g;t& tosm lkleyi gaisdosin si petsosnaonu prthuoxameno.

liopacogdleEmiiyl, eannsuostpo heopuramnoxt si sotm asaiodtecs itwh nhti esalm

hello  Wait, maybe this is wrong logic? Please correct me regarding the exam findings if needed. +  
hello  Can confirm that this explanation is INCORRECT regarding trachea. Disregard this explanation. +  



 -1 
submitted by its_raining_jimbos(21),
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yrvrehEeew I ndufo oeUTpt(Da dna sevrael ae)prps idas teh kgoimsn si eth sieggtb skri rctfao ofr sostnnoepau extnmp,ouhoar tiwh ydbo hausitb adn rgnede bngie a lesser si.kr Am I tjsu tlecomylep studndnsmgriniea het quets?noi

imresident2020  Yes smoking is a risk factor but not the best option among the choices given. Check FA, it says that it occurs more in tall thin young males. Smoking isn’t even mentioned. Tall & thin males are more at risk because they have more negative intrapleural pressure. Check Uworld for this. +  
drdoom  You have to think about this using the concept of CONDITIONAL PROBABILITY. Another way to ask this type of question is like this: “I show you a patient with spontaneous pneumothorax. Which other thing is most likely to be true about this patient?” Said a different way: Given a CONDITION [spontaneous pneumo], what other finding is most likely to be the case? Still other words: Given a pool of people with spontaneous pneumothorax, what other thing is most likely to be true about them? In other words, of all people who end up with spontaneous pneumo, the most common other thing about them is that they are MALE & THIN. If I gave you a bucket of spontaneous pneumo patients -- and you reached your hand in there and pulled one out -- what scenario would be more common: In your hand you have a smoker or in your hand you have a thin male? The latter. +  
cocoxaurus  Rupture of pulmonary blebs are a common cause of spontaneous pneumothorax in young adult males that are tall and thin. I know it's also associated with smoking, but gender and body habitus seemed like the more likely answer here since the patient is a young male. +1