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Thoracic Trauma: Rib Fractures, Sternal Fractures, Scapular and Clavicular Fractures, Pneumothorax, Hemothorax, Pulmonary Contusion

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Thoracic Trauma- Surgical Diseases 4th Year- PMU

Thoracic Trauma- Surgical Diseases 4th Year- PMU

Question 1 of 16

1

Flashcards at
https://quizlet.com/_6rwjjn

Select one of the following:

  • True
  • False

Explanation

Question 2 of 16

1

How many types of pneumothorax are there?

Select one of the following:

  • two

  • three

  • four

  • five

Explanation

Question 3 of 16

1

What is the initial management of an open pneumothorax?

Select one of the following:

  • no emergency treatment is needed

  • suture of the wound

  • promptly closing the defect with a sterile occlusive dressing

  • emergency thoracotomy

Explanation

Question 4 of 16

1

Which of these statements is true for the tension pneumothorax?

Select one of the following:

  • 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

Explanation

Question 5 of 16

1

What other condition can be initially confused with tension pneurnothorax?

Select one of the following:

  • flail chest

  • open pneumothorax

  • myocardial infarction

  • cardiac tamponade

Explanation

Question 6 of 16

1

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

Select one of the following:

  • Placement of a left chest tube

  • Immediate thoracotomy

  • Immediate celiotomy

  • Esophagogastroscopy

  • Removal and replacement of the nasogastric tube; diagnostic peritoneal lavage

Explanation

Question 7 of 16

1

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

Select one of the following:

  • Take a chest x-ray

  • Draw arterial blood for blood gas determination

  • Decompress the right pleural space

  • Perform pericardiocentesis

  • Administer intravenous fluids

Explanation

Question 8 of 16

1

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

Select one of the following:

  • 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

Explanation

Question 9 of 16

1

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

Select one of the following:

  • admission and observation

  • peritoneal lavage

  • exploratory thoracotomy

  • exploratory celiotomy

  • local wound exploration

Explanation

Question 10 of 16

1

Regarding myocardial contusion from blunt chest trauma, which of the following statements is correct?

Select one of the following:

  • 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

Explanation

Question 11 of 16

1

Which of the following situations would be an indication for performance of a thoracotomy in the emergency room?

Select one of the following:

  • 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

Explanation

Question 12 of 16

1

How do we define a massive hemothorax?

Select one of the following:

  • 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

Explanation

Question 13 of 16

1

What is the initial treatment of hemothorax?

Select one of the following:

  • a rapid crystalloid infusion

  • insertion of a chest tube

  • blood transfusions as soon as possible

  • all of the above

Explanation

Question 14 of 16

1

What is the definition of flail chest?

Select one of the following:

  • 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

Explanation

Question 15 of 16

1

What causes the. greatest physiologic insult in patients with flail chest?

Select one of the following:

  • the multiple rib fractures

  • the abnormal chest wall movement

  • the massive blood loss

  • the pulmonary contusion

Explanation

Question 16 of 16

1

What is the mast important part in the treatment of patients with pulmonary contusion?

Select one of the following:

  • emergency thoracotomy

  • treatment of posttraumatic lung infection

  • observation and follow-up

  • blood transfusions

  • all of the above

Explanation

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