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NBME Step 2 CK Form 6 Answers

step2ck_form6/Block 1/Question#44 (reveal difficulty score)
A 4-year-old boy is brought to the emergency ...
Pulmonary contusion ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ / ๐Ÿ“–
tags: pulm

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 +5  upvote downvote
submitted by โˆ—carolebaskin(109)


(a) ARDS is bilateral

(b) aspiration PNA is too quick (4 hours!) and is usually consolidated

(c) fat embolism is more common with long bone fractures (e.g., femur) -- if you hear chest is bruised, think chest first

(d) hemothorax is usually more acute, but I suppose possible especially if you're thinking flail chest with sharp ribs causing puncture. But, x-ray would be more consolidated

(e) pulmonary contusion fits. You have trauma, initially normal ABG, chest bruising, and unilateral diffuse consolidation a few hours later

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drdoom  very neat. very structured. to-the-point, practical breakdowns. but also great use of typographical elements ... ๐Ÿค” too neat for emergency medicine. maybe gen surg? too good natured for ob/gyn .. hmmm, maybe future peds surg? okay, that's my final answer: peds surg. +5
drdoom  no, wait .. iโ€™m revising to peds specialty. probably peds nephro. final answer. +3
charcot_bouchard  One thing i like to add contusion can be U/L or B/L. ARDS develops within 6-72 a/c to uw (24-72 in one place) hours of trauma i.e not too early not too late. The use of diffuse made me pause for a bit. Contusion is within 24 hours. and can progress to ARDS +

 +1  upvote downvote
submitted by โˆ—step_prep7(71)
  • Patient with blunt thoracic trauma who presents <24 hours later with symptoms (tachypnea, tachycardia, hypoxia) and/or CT/CXR infiltrates over affected area (patchy, alveolar)
  • Key idea: Important to differentiate from ARDS, which can have similar presentation but often occurs 24-48 hours after trauma
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