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NBME Step 2 CK Form 8 Answers

step2ck_form8/Block 1/Question#29 (reveal difficulty score)
A comatose 29-year-old woman is brought to ...
Pneumothorax ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ / ๐Ÿ“–
tags: pulm

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submitted by โˆ—carolebaskin(109)
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(E) Pneumothorax

Benzo overdose --> intubation --> airway trauma --> pneumothorax

Wrong answers

(A) Aspiration PNA is possible with individuals prone to loss of consciousness, but would not be so acute! She was intubated then crashed 20 minutes later.

(B) Kerley B lines are indicative of pulmonary edema

(C) Pericardial effusion is characterized by Beck's Triad of hypotension, distended neck veins, and muffled heart sounds. And would not explain unilateral diminished breath sounds.

(D) pleural-based hump-shaped density probably describes a Hampton hump, which a wedge-shaped opacity in peripheral lung with its base at a thoracic wall. Caused by pulmonary infarction.

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 +2  upvote downvote
submitted by โˆ—step_prep(148)
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  • A patient who likely came to ED with altered mental status in the setting of benzodiazepine overdose is intubated and then becomes agitated, hypoxic, tachycardic and hypotensive most concerning for a tension pneumothorax
  • Key idea: Trauma and mechanical ventilation are two major risk factors for tension pneumothorax
  • Key idea: Ventilator would have high-pressure alarms in this setting because the machine is likely trying to push the same amount of air into the lungs even though the volume has been cut in half

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