How much pleural fluid does a normal healthy adult have in each hemithorax?

Which of the following statements about pleural fluid is false?

It can move easily between each hemithorax.

Pleural fluid with a total protein concentration of less than 50% of the serum total protein level is one of the indications of transudative pleural effusion.

True

What is the most common cause of pleural effusion in the clinical setting?

Congestive heart failure

The pleural effusions associated with heart failure are rarely drained.

Pleural effusion is a complication of ascites in less than 10% of the cases.

The most common cause of pleural effusion due to lymphatic obstruction within the mediastinum is which one of the following?

Cancer that has metastasized to the mediastinum

Most pleural effusions are transudative.

Exudative pleural effusions have more protein and inflammatory cells present compared to transudative effusions.

True

Which of the following conditions is most closely associated with exudative pleural effusion?

Tuberculosis

Your patient is 70 years old and has a large unilateral pleural effusion. What is most likely to be the cause?

Malignancy

What is a common complication of pleurodynia (pleural pain)?

Atelectasis

Chylothorax

What is the most common cause of hemothorax?

What is the most common cause of chylothorax?

Malignancy

What is the most sensitive test for detecting a small pleural effusion?

Which of the following is not a typical complication of thoracentesis?

Rib fracture

Pleural effusions from what etiology are most often treated with pleurodesis?

Malignancy

What agent has proven to be the most successful in pleurodesis?

Talc suspended in sterile saline

Chest pain occurs in only a small percentage of patients with a pneumothorax.

False

Primary spontaneous pneumothorax occurs in a patient with no previous underlying lung disease.

Dyspnea occurs in the majority of patients with a pneumothorax.

What is the purpose of a chest tube in a patient with blunt chest trauma that causes bleeding and a pneumothorax?

Measure the rate of bleeding

To tamponade bleeding

To improve ventilation

In what age group is a primary spontaneous pneumothorax most commonly seen?

18 to 25 years

Which of the following risk factors has been associated with the onset of a spontaneous pneumothorax?

What underlying lung disease is most often present in a patient with secondary spontaneous pneumothorax?

Chronic obstructive pulmonary disease

At what intercostal space should the 18-gauge Jelco catheter be placed for the treatment of a tension pneumothorax?

Chest tubes should be directed toward the base of the lung when used to drain a pneumothorax.

Which of the following techniques can be useful in the reduction of leaks through a bronchopleural fistula in a mechanically ventilated patient?

Lowering tidal volume (V_T)

Identify the major anatomic alterations of the lungs associated with flail chest. A = YES—This is associated with flail chest; B = NO—This is not associated with flail chest.

Interstitial edema

Identify the major anatomic alterations of the lungs associated with flail chest. A = YES—This is associated with flail chest; B = NO—This is not associated with flail chest.

Compression of great vessels and decreased cardiac return

Identify the major anatomic alterations of the lungs associated with flail chest. A = YES—This is associated with flail chest; B = NO—This is not associated with flail chest.

Atelectasis

Identify the major anatomic alterations of the lungs associated with flail chest. A = YES—This is associated with flail chest; B = NO—This is not associated with flail chest.

secondary pneumonia

Identify the major anatomic alterations of the lungs associated with flail chest. A = YES—This is associated with flail chest; B = NO—This is not associated with flail chest.

bronchospasm

Identify the major anatomic alterations of the lungs associated with flail chest. A = YES—This is associated with flail chest; B = NO—This is not associated with flail chest.

Pulmonary capillary congestion

Identify the major anatomic alterations of the lungs associated with flail chest. A = YES—This is associated with flail chest; B = NO—This is not associated with flail chest.

Pulmonary capillary congestion

Identify the major anatomic alterations of the lungs associated with flail chest. A = YES—This is associated with flail chest; B = NO—This is not associated with flail chest.

Fibrosis and calcification of lung parenchyma

Identify the major anatomic alterations of the lungs associated with flail chest. A = YES—This is associated with flail chest; B = NO—This is not associated with flail chest.

Lung collapse (pneumothorax)

Identify the major anatomic alterations of the lungs associated with flail chest. A = YES—This is associated with flail chest; B = NO—This is not associated with flail chest.

Lung contusion

Identify the major anatomic alterations of the lungs associated with flail chest. A = YES—This is associated with flail chest; B = NO—This is not associated with flail chest.

Alveolar hyperinflation (air trapping)

Identify the major anatomic alterations of the lungs associated with flail chest. A = YES—This is associated with flail chest; B = NO—This is not associated with flail chest.

alveolar inflammation

Identify the major anatomic alterations of the lungs associated with flail chest. A = YES—This is associated with flail chest; B = NO—This is not associated with flail chest.

distortion and dilation of the bronchi

Identify the major anatomic alterations of the lungs associated with flail chest. A = YES—This is associated with flail chest; B = NO—This is not associated with flail chest.

Excessive bronchial ssecretions (severe)

Identify the major anatomic alterations of the lungs associated with flail chest. A = YES—This is associated with flail chest; B = NO—This is not associated with flail chest.

Rib instability

Identify the major anatomic alterations of the lungs associated with flail chest. A = YES—This is associated with flail chest; B = NO—This is not associated with flail chest.

Frothy white (or pink) bronchial secretions

Identify the major anatomic alterations of the lungs associated with flail chest. A = YES—This is associated with flail chest; B = NO—This is not associated with flail chest.

Lung volume restriction

Identify the major anatomic alterations of the lungs associated with flail chest. A = YES—This is associated with flail chest; B = NO—This is not associated with flail chest.

Permanent enlargement and deteriorations of the alveoli

Identify the major anatomic alterations of the lungs associated with flail chest. A = YES—This is associated with flail chest; B = NO—This is not associated with flail chest.

Double fracture of numerous adjacent ribs

A flail chest is the result of double fractures of at least three adjacent ribs, which causes the thoracic cage to become unstable.

The shunting of air from one lung to another as the result of a flail chest is known as paradoxical movement of the chest.

The patient's RVSWI increases because of a severe flail chest.

As a result of a severe flail chest, the patient's CO decreases.

The shunting of air from one lung to another is known as pendelluft.

The fractured ribs of a severe flail chest commonly move outward during expiration.

The irritant receptors may be stimulated in a flail chest.

During the advanced stages of severe flail chest, the increased HCO₃^- level in ABG’s is secondary to the increased P_aCO₂.

Paradoxic chest movement due to a flail chest may lead to an increased respiratory rate.

Which of the following occurs with severe flail chest?

I.    Venous return increases

II.   Cardiac output decreases

III. Systemic blood pressure increases

IV.  Central venous pressure increases

II, III, IV

As a consequence of a severe flail chest, which of the following PFT changes occur?

I.    RV increases

II, III, IV

Volume-controlled ventilation and PEEP are commonly used to stabilize a severe flail chest.

When mechanical ventilation is used to stabilize a flail chest, how much time is generally needed for bone healing?

5-10 days

When gas moves freely between the pleural space and the atmosphere during ventilation, the patient is said to have an open chest wound.

When a patient has a valvular pneumothorax due to a sucking chest wound, the intrapleural pressure on the affected side increases during exhalation.

The breath sounds over a pneumothorax are diminished.

A sucking chest wound occurs when trauma put the pleural space in direct contact with the atmosphere and air moves in and out of the pleural cavity.

Tracheal shift is a common clinical finding with a pneumothorax.

Gas-forming microorganisms can cause a pneumothorax.

After the lung has re-expanded and bubbling from the chest tube has ceased, the tube is left in place for another 24 to 48 hours.

Which is not a major pathologic change caused by a pneumothorax?

A.     Lung collapse

B.     Decreased venous return

C.     Hyperexpansion of the chest wall

D.     Secondary pneumonia

Which is incorrect about a spontaneous pneumothorax?

A.     It often occurs in tall, thin, young persons

B.     It’s secondary to underlying pathologic processes

C.     Some spontaneous pneumothoraces are iatrogrenic

D.     It may result from high pressures in the upper lung

Which of the following may cause a pneumothorax?

I.    Pneumonia

II.   Tuberculosis

III. COPD

IV.  Blebs

I, II, III, IV

Which is not a common chest x-ray finding of a pneumothorax?

A.     Atelectasis

The increased ventilatory rate commonly manifested in patients with pneumothorax may result from which of the following?

I.    Stimulation of the J receptors

II.   Increased lung compliance

III. Increased stimulation of the Hering-Breuer reflex

IV.  Stimulation of the irritant reflex

The physician usually elects to evacuate the intrathoracic gas when the pneumothorax is greater than:

A.     15%

B.     5%

C.     10%

D.     20%

20%

When treating a pneumothorax with a chest tube and suction, the negative pressure usually need not exceed:

12 cm H₂O

Spontaneous resorption of a relatively small pneumothorax usually occurs within a week.

When a patient has a large tension pneumothorax, which of the following occurs?

I.    P_aCO₂ decreases

II.   pH increases

III. HCO₃^- decreases

IV.  P_aCO₂ increases

When a patient has a large tension pneumothorax, what occurs?

I.    PVR decreases

II.   PA increases

III. CVP decreases

IV.  CO increases

The most common cause of a pleural effusion is pneumonia.

The clinical manifestations associated with pleural effusion are based on the clinical scenarios activated by distal airway and alveolar weakening.

The accumulation of pus in the pleural cavity is called empyema.

Pleurodesis causes the visceral and parietal pleurae to stick together and not allow fluid accumulation between them.

Occasionally a transudative pleural effusion can develop as a complication of hepatic cirrhosis.

An exudative pleural effusion has a low protein content.

Trauma to the neck commonly causes what is called a chylothorax.

A tracheal shift is commonly associated with a pleural effusion.

Congestive heart failure is a common cause of an exudative pleural effusion.