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the emergency department. On
334. An 18-year-old man presents to examination, subcutaneous
the emergency department with a emphysema of the right chest wall,
gunshot wound to the left chest in absent breath sounds, and a trachea
the anterior axillary line in the sixth shifted to the left are noted. What is
intercostal space. His blood pressure the most likely diagnosis?
is 120/70 mm Hg, pulse 78 bpm. A. Pneumothorax
A sucking sound is audible during B. Tension pneumothorax
inspiration. Immediate management C. Massive hemothorax
is which of the following? D. Hemopneumothorax
A. Exploratory laparotomy E. Chest wall laceration
B. Exploratory thoracotomy
C. Pleurocentesis 338. A 31-year-old man is shot in the
D. Closure of the hole with sterile back of the left chest, and the bullet
dressing exits the left anterior chest. The
E. Insertion of central venous access patient s blood pressure is 130/90
line mm Hg, respiration rate is 28
breaths per minute, and pulse is 110
335. While landing at the end of flight bpm. A chest x-ray reveals
a young man develops shortness of hemothorax. A chest tube is inserted
breath and rightsided pressure chest and yields 800 mL of blood; the
pain. He is tall and thin. He has not first and second hour drainage is
previously consulted a doctor. A 200 mL/h and 240 mL/h,
chest film is likely to show? respectively. What is the next step
A. Left pleural effusion in management?
B. Spontaneous pneumothorax A. Place a second chest tube
C. Dilated stomach B. Collect the blood for
D. Hemothorax autotransfusion
E. Cardiomegaly C. Transfuse and observe drainage
for another hour
336. While landing at the end of flight D. Insert a Swan-Ganz catheter
a young man develops shortness of E. Perform a left thoracotomy
breath and rightsided pressure chest
pain. He is tall and thin. He has not
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339. A 31-year-old man is shot in the Patients with COPD; 4. Patients
back of the left chest, and the bullet with multiple rib fractures; 5.
exits the left anterior chest. The Patients with flail chest.
patient s blood pressure is 130/90 A. 1, 2, 3
mm Hg, respiration rate is 28 B. 2, 4, 5
breaths per minute, and pulse is 110 C. 3, 4, 5
bpm. A chest x-ray reveals D. 1, 2, 4
hemothorax. A chest tube is inserted E. All are correct
and yields 800 mL of blood; the
first and second hour drainage is 343. Which statement is wrong
200 mL/h and 240 mL/h, concerning sternal fracture?
respectively. In the patient A. Is seen in 60% of patients with
described above the most likely blunt trauma
cause of the bleeding is injury to B. Is very uncommon injury
which of the following? C. Needs large traumatic force
A. Pulmonary artery D. Is caused by direct blow to front
B. Lung parenchyma of the chest
C. Internal thoracic (mammary) E. Is associated with high rate of
and/or intercostals arteries myocardial contusion and cardiac
D. Pulmonary vein tamponade
E. Left atrium
344. A 25-year-old man is shot in the
340. Which statement concerning 1st left lateral chest. In the emergency
and 2nd ribs fractures is wrong? department, his blood pressure is
A. Require high force 120/90 mm Hg, pulse rate is 104
B. Frequently have injury to aorta beats per minute (bpm), and
C. Frequently have injury to bronchi respiration rate is 36 breaths per
D. May injure subclavian minute. Chest x-ray shows air and
artery/vein fluid in the left pleural cavity.
E. Causes pulsus paradoxicus Nasogastric aspiration reveals
blood-stained fluid. What is the best
341. Most oftenly fracture of 11th or step to rule out esophageal injury?
12th ribs are associated with: A. Insertion of chest tube
A. Flail chest B. Insertion of nasogastric tube
B. Damage to underlying abdominal C. Esophagogram with gastrografin
solid organs (liver, spleen, kidney) D. Esophagoscopy
C. Injury to aorta E. Peritoneal lavage
D. Injury to bronchi
E. Pneumothorax 345. Because of his involvement in a
motor vehicle accident, a 23-year-
342. In what cases patients with rib old football player has a chest wall
fractures should be treated injury. The only abnormal findings
immediately or monitored carefully: on clinical and radiologic
1. Elderly patients; 2. Patients with examination are a fracture of the left
concomitant heart diseases; 3. fifth to seventh ribs and a small
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hemothorax. What should treatment
include? 348. A 40-year-old woman is brought
A. Insertion of an intercostal drain to the emergency department
to avoid pneumothorax following a car crash in which she
B. Thoracotomy to treat a small was the driver. In the emergency
hemothorax in the left base department, her blood pressure is
C. Insertion of a metal plate to fix 80/60 mm Hg, pulse is 128 bpm,
the fracture and respiratory rate is 36 breaths per
D. Administration of analgesic minute. She complains of right
medication lower chest wall and severe right
E. Administration of cortisone to upper quadrant (RUQ) tenderness.
prevent callus formation Her breath sounds are questionably
diminished. The immediate priority
346. A 25-year-old woman was stabbed is to perform which of the
by her boyfriend in the left chest. following?
On examination, she has a 1-cm A. Peritoneal lavage
stab wound just inferior to her left B. Chest x-ray
breast in the mid-clavicular line. C. CT scan of chest and abdomen
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