Unit 3 Lecture 1

Question 1

how much blood can be in the pleural space before it shows on CXR?

Answer 1

200-300ml

Question 2

signs/sxs of penetrating chest traum

Answer 2

hemoptysis, pneumothorax, subcutaneous emphysema, mediastinal emphysema, dullness/absent breath sound

Question 3

beck’s triad (tamponade)

Answer 3

JVD, hypotension, and muffled heart sounds

Question 4

workup for penetrating chest trauma

Answer 4

CT, Echo, angio (if bleeding out but not sure form where)

Question 5

what is the LD50 for falls

Answer 5

4 stories (stated in class, slide 8)

Question 6

most common side for traumatic diaphragmatic hernia

Answer 6

left side

Question 7

signs of traumatic diaphragmatic hernia

Answer 7

resp. distress, decreased breath sounds, BS in the chest, abd pain, paradoxical respiration

Question 8

tx for traumatic diaph. hernia

Answer 8

trans-abdominal repair (come from below and pull intestines down)

Question 9

how many ribs involved for flail chest

Answer 9

3+

Question 10

tx for pt with 1-2 non-displaced rib fractures with no signs/sxs of more significant injury

Answer 10

treat for pain (NSAIDs +/- narcotics) and d/c

Question 11

complications of rib fractures

Answer 11

atelectasis and PNA

Question 12

if pt does not improved from rib fracture, when should follow up xray be taken

Answer 12

4-6 week

Question 13

how often should you get a chest xray when pt has a hemothorax

Answer 13

q8h

Question 14

xray finding for pulmonary contusion

Answer 14

irregular, nonlobular opacification of the pulmonary parenchyma

Question 15

complications of pulm. contusion

Answer 15

resp. distress, hemoptysis, PNA

Question 16

tx of pulmo. contusion

Answer 16

pain control and pulm. toilet

Question 17

most common cause of sternal fractures

Answer 17

steering wheel impact

Question 18

level of the carina

Answer 18

T5

Question 19

level of esophageal hiatus

Answer 19

T9-10

Question 20

what is achalasia

Answer 20

loss of peristalsis in the distal esophagus and a failure of lower esophageal sphincter relaxation with swallowing

Question 21

most common epidemiology of achalasia

Answer 21

primary dysmotility

Question 22

sxs of achalasia

Answer 22

dysphasia with solids, followed by dysphagia to liquids, regurg after meals, heartburn

Question 23

dx of achalasia (test of choice)

Answer 23

esophageal manometry

Question 24

finding on barium esophagram c/w achalasia

Answer 24

bird’s beak

Question 25

tx for achalasia

Answer 25

nitrate or Ca channel blockers to reduce LES tone | -botulism, pneumatic dilatation

Question 26

most common cause of esophageal perf.

Answer 26

trauma (iatrogenic)

Question 27

location of instrument esophageal perfs

Answer 27

cervical esophagus

Question 28

location of spontaneous esophageal perfs

Answer 28

distal esophagus

Question 29

hamman's sign

Answer 29

audibly crunchy rasping sound synchronous with the heart beat

Question 30

dx of esophageal perf

Answer 30

CXR-signs of perf | esophagogram- with gastrograffin

Question 31

tx of esophageal perf

Answer 31

NPO, IVF, abx, NGT -observe vs surgery (large perf +/- signs of mediastinitis, sepsis, shock require emergent surgery)

Question 32

boerhaave syndrome is a/w what?

Answer 32

violent vomiting an wretching

Question 33

most common location of perf with boerhaave syndrome

Answer 33

left posterolateral distal esophagus

Question 34

tx of boerhaave

Answer 34

ABC, abx, surgery!

Question 35

most common cause of hemoptysis

Answer 35

bronchitis | bacterial accounts for 70%

Question 36

management of hemoptysis

Answer 36

ABCs, bronchoscopy->angiography (dx and tx)

Question 37

definition of spontaneous pneumothorax

Answer 37

collection of air within the pleural space with collapse of the affected lung

Question 38

who is most likely to have spontaneous pnuemothorax

Answer 38

teens, young adults, tall thin men

Question 39

sxs of spont. pneumo.

Answer 39

sudden onset of pleuritic chest pain and dyspnea

Question 40

PE of spont. pneumo.

Answer 40

tachycardia, decreased breath sounds, hyperresonance

Question 41

tx of spont. penumo.

Answer 41

30%=chest tube

Question 42

when should pt with spont. pneumo undergo video assisted thoroscopy (VATs)

Answer 42

recurrent pneumothorax, failure to resolve, persistent air leak

Question 43

definition of tension pneumothorax

Answer 43

pneumothorax with mediastinal shift which can impair venous return and cause HYPOtension and cardiac arrest

Question 44

PE of tension pneumothorax

Answer 44

hyperresonance, decreased breath sounds, tracheal shift, HYPOtension or PEA

Question 45

placement of angiocatheter to treat tension penumothorax

Answer 45

2nd ICS MCL