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Retired NBME 23 Answers

nbme23/Block 4/Question#21 (reveal difficulty score)
An otherwise healthy 26-year-old scuba diver ...
Hyperresonance over most of the left side of the chest ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ / ๐Ÿ“–
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 +17  upvote downvote
submitted by โˆ—sympathetikey(1600)
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Hard to see due to poor picture quality, but based on what I could see, it seems like a spontaneous pneumothorax to me (based on the lack of lung marking on the left compared to the right side).

Therefore, since the lung is deflated, all you would have in the left side of the open cavity, which would make the left side hyperressonant.

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sugaplum  FA 2019 pg667 +18



 +1  upvote downvote
submitted by โˆ—mdmikek89(6)
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Pulmonary barotrauma is a lung overexpansion injury that typically occurs when a diver fails to exhale properly, or holds their breath during ascent. Compressed gas in the lungs expands as the diver ascends and can cause the lungs to rupture if not exhaled

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 -2  upvote downvote
submitted by โˆ—krewfoo99(115)
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My reasoning:

As you go below sea level, there is an increase in atmospheric pressure. Increase in the pressure may cause rupture of subpleural blebs leading to pneumothorax.

Not sure if this is entirely correct though.

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 -2  upvote downvote
submitted by โˆ—thotcandy(131)
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So the xray was similar to this

this is a large volume gas emboli (which you would expect from a diver due to nitrogen precipitation). You can kinda see it in the xray overlapping the heart shadow/left diaphragm.

This is a giant pocket of air, basically so I just figured it would be hyper-resonant due to hyperinflation.

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