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NBME 21 Answers

nbme21/Block 1/Question#5 (reveal difficulty score)
A 45-year-old woman is brought to the ...
Absorption atelectasis ๐Ÿ” / ๐Ÿ“บ / ๐ŸŒณ
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 +83 
submitted by haldol(12),
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PB is lwo so lovsyibou teh yodb ilwl tnaw ot enrdosp yb asnringeci acetsmyishtp and cernsiaged teacya.tsmparhsip ecnis teh PB is owl, trhee is elss sepsuerr iasgtna the lwla fo teh dcraoit nussi -- nngemia ssle lmoiuttasni nad ewerf ls.upisme feewr oatdrci mslpseiu amens wefer yaapttehspcarmsi


 +74 
submitted by โˆ—nosancuck(93),
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Bhur let me letl yuo a lil tcsree

EPPE evsernpt ciaetslsAte AAK tad ULNG ESLPOLCA

noDt eb roywirn botau moradn doswr eyth tsup in orftn fo hte IHHG ELYID nseo

hungrybox  literally LOL'd lmao I love this +15  



 +2 
submitted by โˆ—chandlerbas(111),
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buhconrs rtcibounost tp sar goyexn ni laioevl n o nentgoir ebla ot etenr oapemshci(rt rai inetrgne oybd 8(%7 tnonigre nda 2%1 ,eynoxg inorgetn si so inomttpra geinnotr bc it si a rolopy dbbrseoa gas nda suth si ni eacrghd fo kngeeip ovlaiel xaitgf )eydolnne ni eht eiaovll is dabrsboe oitn eth icbg roounddel hte eolumv fo hte vloaolale avrile seocallp tsp ironoba caelatsseit

bethune  Why is pulmonary hypertension incorrect? +1  
samsam3711  PEEP allows the alveoli to remain slightly open with exhalation to prevent atelectasis. Pulmonary Hypertension is going to be related to vascular changes (instead you might see shunting of blood in areas of poor ventilation) +2  
drzed  Pulmonary HTN occurs because of pulmonary vessel vasoconstriction. This can occur d/t multiple factors, but one of the most important ones is hypoxic vasoconstriction that the lungs will undergo (for example, at altitude). In the setting of PEEP, you are ventilating the lungs perfectly; this allows for the pulmonary vessels to open up and not undergo vasoconstriction. Thus, you prevent pulmonary hypertension via hypoxia. +1  
peridot  @drzed by your logic, you're arguing for D to be the answer but the correct answer was about preventing atelectasis +1  
medstudent  The question is whatโ€™s key. The purpose of PEEP is to keep the airway open. The purpose of ventilation with supplemental oxygen can help with preventing pulm HTN. Could be wrong, but thatโ€™s what makes sense to me. +1  



 +1 
submitted by โˆ—haliburton(222),
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iikdiapwe ps)igoa(ole: The epstrehoma is pmdseooc of 7%8 niortegn adn 21% xgneoy. eSinc eonyxg si hxeagnecd at teh lpar-eyivoillacla eb,nramme nogrinet si a ormja pcnoeonmt ofr eht loasl'evi teats of fniolnat.i If a lager evolmu fo ngitneor in eht nglus is cldpraee itwh ey,goxn the ognxye aym bnelqsyteusu eb sebbdrao itno eht ,olbod eiducgnr teh ouevlm of eth eliav,ol gnresutli ni a from of olvralae lcpseloa nwonk sa ibarsnotop c.iaaeltsset

I hseco egnidcoraic dae,em btu I eeibelv tihs si ertinrcoc ecabsue three si no areth rfulaei rksi at hits m,tie so het repuops of teh EPEP is ecrylatin ton ot sphu out .dlufi

bighead478  doesn't there have to be an airway obstruction (mucus, foreign object etc.) in order for this to happen? 100% O2 without any airway obstruction should not cause absorption atelectasis, right? +1  
iloveallpotatoes  And Tension Pneumothorax is wrong bc PEEP would furthur exacerbate that. +2  
hyperfukus  @iloveallpotatoes yea i realized that now after getting it wrong :( +1  
plzhelp123  @bighead478, they are using a cuffed endotracheal tube and mechanically ventilating this patient which is creating an iatrogenic "obstruction" and as @haliburton mentioned, having a high FiO2 leads to over-absorption by the blood which leads to absorption atelectasis if no other gas is allowed to enter/there is no communication with atmospheric pressure during expiration. Thus, we add positive end-expiratory pressure which keeps alveoli open at the end of expiration to prevent collapse +1  



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