need help with your account or subscription? click here to email us (or see the contact page)
join telegramNEW! discord
jump to exam page:
search for anything ⋅ score predictor (โ€œpredict me!โ€)

Retired NBME Step 2 CK Free 120 Answers

step2ck_free120/Block 1/Question#37 (reveal difficulty score)
A 4-year-old boy with asthma becomes limp ...
Decrease in cardiac output ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ / ๐Ÿ“–
tags: cardio Pulm

 Login (or register) to see more


 +1  upvote downvote
submitted by โˆ—azibird(279)
get full access to all contentpick a username

What the hell is going on here? Still no answer that makes sense. We have:

  • "Poor air movement, especially on the LEFT"
  • What looks like a RIGHT tension pneumothorax on CXR
  • Shock and stupor ensue...
  • Oh, and also hypovolemic shock and maybe a weirdly shifted PMI

Put it all together: RIGHT tension pneumothorax

But why the hell are breath sounds decreased on the LEFT? That alone made me switch to some crazy heart crushing atelectasis answer. I honestly thing the R/L mixup may be a typo because without that the question is simple.

get full access to all contentpick a username



 +0  upvote downvote
submitted by โˆ—bwdc(697)
get full access to all contentpick a username

The radiograph is showing complete collapse of the left lung (2/2 mucous plugging) with resultant severe ipsilateral mediastinal shift. An acute shift can have the same effect as any other โ€œtensionโ€-type process, causing impaired venous return to the heart and decreased cardiac output via the Starling mechanism.

get full access to all contentpick a username
amayap  do you mean collapse of the right lung and contralateral mediastinal shift=spontaneous secondary pneumothorax from plugging +
tomatoeandspinach  This is what I was thinking. Atelectasis โ†’ mucous plugging โ†’ spontaneous secondary ptx? Atelectasis does not decrease C.O. as far as I know. +
tomatoeandspinach  You're saying that the trachea shift is impeding venous return to the left heart. I don't think this is a "tension pneumothorax" by definition - TPTX causes c/l shifting. +



Must-See Comments from step2ck_free120

mmizell on S1 radiculopathy
len49 on Increased total protein concentration
bwdc on Cardiovascular disease
bwdc on Discuss the familyโ€™s goals for the patient
anonmedstudent on Skeletal survey
carolebaskin on Axillary-subclavian venous thrombosis
bwdc on Discharge the patient with a plan for home ...
bwdc on Echocardiography
bwdc on Selection bias
bwdc on Immobilization of the right foot in a ...
bwdc on Ultrasonography
bwdc on Arteriovenous fistula
bwdc on Hepatitis C
bwdc on Multiple myeloma

search for anything NEW!