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Thoracic Trauma- Surgical Diseases 4th Year- PMU

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Thoracic Trauma: Rib Fractures, Sternal Fractures, Scapular and Clavicular Fractures, Pneumothorax, Hemothorax, Pulmonary Contusion
Med Student
Quiz by Med Student , updated more than 1 year ago
Med Student
Created by Med Student almost 5 years ago
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Resource summary

Question 1

Question
Flashcards at https://quizlet.com/_6rwjjn
Answer
  • True
  • False

Question 2

Question
How many types of pneumothorax are there?
Answer
  • two
  • three
  • four
  • five

Question 3

Question
What is the initial management of an open pneumothorax?
Answer
  • no emergency treatment is needed
  • suture of the wound
  • promptly closing the defect with a sterile occlusive dressing
  • emergency thoracotomy

Question 4

Question
Which of these statements is true for the tension pneumothorax?
Answer
  • we should wait for the chest x-ray to confirm the diagnosis before proceeding with the treatment
  • the mediastinum is shifted to the opposite side, decreasing the venous return and compressing the opposite lung
  • it results from large defects. of the chest wall that remain open
  • the treatment is emergency thoracotomy
  • all of the above

Question 5

Question
What other condition can be initially confused with tension pneurnothorax?
Answer
  • flail chest
  • open pneumothorax
  • myocardial infarction
  • cardiac tamponade

Question 6

Question
A teenage boy falls from his bicycle and is run over by a truck. On arrival in the emergency room, he is awake and alert and appears frightened but in no distress. The chest radiograph suggests an air-fluid level in the left lower lung field and the nasogastric tube seems to coil upward into the left chest. The next best step in management is
Answer
  • Placement of a left chest tube
  • Immediate thoracotomy
  • Immediate celiotomy
  • Esophagogastroscopy
  • Removal and replacement of the nasogastric tube; diagnostic peritoneal lavage

Question 7

Question
A 25-year-old woman arrives in the emergency room following an automobile accident. She is acutely dyspneic with a respiratory rate of 60 breaths/min. Breath sounds. are markedly diminished on the right side. The first step in managing the patient should be to
Answer
  • Take a chest x-ray
  • Draw arterial blood for blood gas determination
  • Decompress the right pleural space
  • Perform pericardiocentesis
  • Administer intravenous fluids

Question 8

Question
A 25-year-old woman arrives in the emergency room following an automobile accident. She is acutely dyspneic with a respiratory rate of 60 breaths/min. Breath sounds. are markedly diminished on the right side. A chest x-ray of this woman before therapy would probably reveal
Answer
  • Air in the right pleural space
  • Shifting of the mediastinum toward the right
  • Shifting of the trachea toward the right
  • Dilation of the intrathoracic vena cava
  • Hyperinflation of the left lung

Question 9

Question
A 23-year-old previously healthy man presents to the emergency room after sustaining a single gunshot wound to the left chest. The entrance wound is 3 cm inferior to the nipple and the exit wound is just below the scapula. A chest tube is placed that drains 400 mL of blood and continues to drain 50-75 mtL/h during the initial resuscitation. Initial blood pressure of 70/0 mm Hg responds to 2 L crystalloid and is now 100/70 mm Hg. Abdominal examination is “unremarkable. Chest x-ray reveals a reexpanded lung and no free air under the diaphragm. The next management step should be
Answer
  • admission and observation
  • peritoneal lavage
  • exploratory thoracotomy
  • exploratory celiotomy
  • local wound exploration

Question 10

Question
Regarding myocardial contusion from blunt chest trauma, which of the following statements is correct?
Answer
  • Elevated cardiac isoenzyme levels sensitively identify patients at risk for life-threatening arrhythmias
  • The majority of patients have abnormalities on the initial ECG post injury
  • First-pass radionuclide angiography (RNA) and echocardiography are considered the “gold standard” for diagnosis
  • RNA and echocardiography are good predictors of subsequent Cardiac complications such as arrhythmias and pump failure
  • All patients diagnosed with myocardial contusion should be monitored in an intensive care unit setting for 72 h

Question 11

Question
Which of the following situations would be an indication for performance of a thoracotomy in the emergency room?
Answer
  • Massive hemotharax following blunt trauma to the chest
  • Blunt trauma ‘to multiple organ systems with obtainable vita! signs in the field but none on arrival in the emergency roam
  • Rapidly deteriorating patient with cardiac tamponade from penetrating thoracic trauma
  • Penetrating thoracic trauma and no signs of life in the field
  • Penetrating abdominal trauma and no signs of life in the field

Question 12

Question
How do we define a massive hemothorax?
Answer
  • accumulation of more than 300 ml of blood
  • accumulation of more than 1000 ml of blood
  • accumulation of more than 1500 ml of blood
  • accumulation of more than 2500 ml of blood

Question 13

Question
What is the initial treatment of hemothorax?
Answer
  • a rapid crystalloid infusion
  • insertion of a chest tube
  • blood transfusions as soon as possible
  • all of the above

Question 14

Question
What is the definition of flail chest?
Answer
  • multiple rib fractures in one fracture line
  • accumulation of more than 1500 ml of blood in the thoracic cavity
  • multiple rib fractures - three or more ribs fractured in two or more places
  • one rib fractured in two fracture lines

Question 15

Question
What causes the. greatest physiologic insult in patients with flail chest?
Answer
  • the multiple rib fractures
  • the abnormal chest wall movement
  • the massive blood loss
  • the pulmonary contusion

Question 16

Question
What is the mast important part in the treatment of patients with pulmonary contusion?
Answer
  • emergency thoracotomy
  • treatment of posttraumatic lung infection
  • observation and follow-up
  • blood transfusions
  • all of the above
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