MKSAP Pulm Emergencies study guide 2024 questions and answers

A thin 18 year old female complains of acute onset of sharp right-sided chest pain
this morning. She has developed some mild shortness of breath during the morning
and thought she should get it checked out. Her chest X-ray is shown in the Figure.
The next course of action should be:
[image]
A. Chest tube placement
B. Antibiotics
C. Electrocardiogram
D. Needle decompression - The answer is A. This patient has a large right-sided
spontaneous pneumothorax that is not under tension. She needs oxygen and chest
tube placement. This can be done with proper procedural analgesia and sedation
since there is no immediate threat. Primary spontaneous pneumothorax tends to
occur in healthy young men (and, less commonly, women) of taller than average
height. Other risk factors include cigarette smoking, asthma, COPD, interstitial
lung disease, connective tissue diseases, and lung cancers.
A 28 year old patient arrives after helicopter transfer from an outlying center,
where he had been intubated for altered mental status after significant alcohol
intoxication. There were no reported signs of chest trauma, but the patient now has
decreased breath sounds on the left. His vital signs are stable. Based upon the chest
X-ray in the figure, what is the next step in management of this patient?
[image]
A. Nasogastric tube placement
B. Chest tube placement
C. Endotracheal tube adjustment
D. Needle decompression - The answer is C. The patient has a right-mainstem
intubation and resultant opacification of the left lung secondary to unilateral lack
of ventilation. In an adult male, the ETT should generally be inserted to a depth (to
the lip line) of 22-24cm; the corresponding depth range for an adult female is 21-
23cm
A 25-year old female presents to the ED with dyspnea and chest pain. Chest CT,
with contrast, is performed and some pertinent "slices" are shown in the Figure.
What is the diagnosis?
[image]
A. Aortic dissection, Type I
B. Bilateral pulmonary embolism
C. Gas embolism
D. Acute Respiratory Distress Syndrome - The answer is B. Helical CT studies of
the pulmonary vasculature are increasingly used for detection of pulmonary
embolism. Though there are questions about CT's ability to detect small (e.g.
subsegmental) emboli, CT scans have high sensitivity for proximal embolism such
as that depicted in the accompanying figure. The patient whose images are shown
was found to have moderate-severe right ventricular dysfunction and received
thrombolytic therapy in the ED - she had an excellent outcome.
The X-ray in the figure indicates:
[image]
A. Need to withdraw the endotracheal tube from the mainstem
B. A chest radiograph that was taken with the patient rotated
C. Right upper lobe pneumonia
D. Mediastinal shift due to fluid in the right hemithorax - The answer is D. The
patient is not intubated. The pathology in the right hem