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NBME Step 2 CK Form 8 Answers

step2ck_form8/Block 1/Question#4 (reveal difficulty score)
A 67-year-old woman comes to the physician ...
Pulmonary function tests ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ / ๐Ÿ“–
tags: surgery pulm inc

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submitted by โˆ—step_prep(148)
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  • Tricky, nuanced question because contraindication to patient receiving a lung resection is if their residual FEV1 will be less than 800 mL following the surgery

  • Normal FEV1 in a healthy woman is typically around 3 L, so in this patient is likely close to 750 mL since she has an FEV1 that is 25% of predicted; therefore, this patient would likely not be able to tolerate any sort of lung resection because she is already barely hanging on in terms of her ventilatory capabilities

  • Could also approach this question through process of elimination because ABG shows mild CO2 retention (seen in many COPD patients), ejection fraction cut-off for surgery often <35%, cardiac stress test was normal and patient has had DVTs for a long time

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drdoom  very nice +2
osler_weber_rendu  Pestana explains this very well +1
drdoom  pestana? .. auto-corrected from Costanzo, perhaps? +

 +1  upvote downvote
submitted by โˆ—charcot_bouchard(574)
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This pt has mild hypercarbia but worse FEV1. Those are her limiting factor.

EF <35 would be absolute CI. not 40.


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