This page is dedicated to organizing various examples of standardized exam questions whose answer is pneumothorax. While this may seem a odd practice, it is useful to see multiple examples of how pneumothorax will be characterized on standardized exams (namely the boards and the shelf exams). This page is not meant to be used as a tradition question bank (as all of the answers will be the same), however seeing the classic “test” characterization for a disease is quite valuable.
- Trauma (often to the chest): stab wound, gunshot, etc.
- Breath sounds decreased over the affected lung field.
- Hyperreasonacne to percussion over the affected lung field
- Deviated trachea away from the affected lung (in tension pneumothorax)
KEY CHARACTERISTICS OF THIS CONDITION (ON EXAMS)
When it comes to standardized exams, each topic has its own “code” marked by key buzzwords, lab findings, clues, etc. If you are well versed in this code you will be able to more quickly identify the condition that is being discussed, and get the right answer on the exam you are taking. Below is the “code” for pneumothorax.
Question # 1
A 18 year old male is brought to he hospital 30 minutes after being stabbed in the left side of his chest with a letter opener. On the way to the hospital he begins to develop severe chest pain. He is agitated diaphoretic, and does not know where he is, what time it is, or who he is. His temperature is 99.5°F, pulse is 130/min, respirations are 34/min, and palpable blood pressure is 80 mm Hg. A physical exam shows jugular venous distention bilaterally. Breath sounds are decreased on the left lung field, and this lung field is also demonstrates hyperresonance to percussion. What is the likely diagnosis?
Explanation # 1
Stabbing injury + decreased breath sounds + hyperresonance = pneumothorax
Question # 2
A 25 year old male is brought to the emergency department because he had a sudden onset of shortness of breath when scuba diving. He explains that he had to ascend rapidly from a 80 foot depth because he was running low on compressed air. Towards the end of his ascent he felt a sudden onset of chest pain, and then quickly developed shortness of breath soon thereafter. Pulse oximetry reveals an oxygen saturation of 89%. It is noted that the patient is using accessory muscles for respiration and that his trachea is midline. A physical exam reveals decreased breath sounds and hyperresonance to percussion on the right. The remainder of the exam is non-contributory. What is the likely diagnosis in this patient?
Explanation # 2
Sudden pressure change (scuba ascent) + sudden onset chest pain/shortness of breath + hyperreasonance/decreased breath sounds over lung field = pneumothorax
Question # 3
A 60 year old woman is admitted to the hospital for an elective gastrectomy. A subclavian venous catheter is inserted using a left infraclaviuclar approach. After this is done the patient begins to squirm and also has shortness of breath. Her pulse is 105/min, respirations are 26/min, and blood pressure is 110/70 mm Hg. An examination shows jugular venous distention. Breath sounds are decreased over the left lung field. What is the likely diagnosis in this patient?
Explanation # 3
Pneumothorax caused by insertion of the venous catheter.
Question # 4
A 25-year-old male arrives to the hospital with multiple gun shot wounds to the chest and abdomen. He has labored breathing, is cyanotic, diaphoretic, cold and shivering. His blood pressure is 65/40 mm Hg. His pulse rate is 151 and barely palpable. He is in respiratory distress, has big distended veins in his neck and forehead. The patient’s trachea is deviated to the right, and the left side of his chest is tympantic, with no breath sounds.
Explanation # 4
Gunshot to chest + distended veins in neck/head + deviated trachea + tympanic chest w/absent breath sounds = pneumothorax (tension)
Question # 5
A 28-year-old man is stabbed in the left chest. He is moderately short of breath, has stable vital signs. No breath sounds on the left. Resonant to percussion on the left.
Explanation # 5
Penetrating trauma to chest + no breath sounds + resonant to percussion = pneumothorax
Question # 6
A 35 year old woman is involved in a motor vehicle accident. She comes to the hospital gasping for breath, and is cyanotic at the lips. Her nostrils flair as she tries to breathe. There are bruises over both sides of her chest and there is also tenderness present that suggests multiple fractured ribs. Her blood pressure is 65/40 mm Hg. Her heart rate is 155 ppm, and is difficult to palpate. She has distended neck and forehead veins. Her left lung field does to have any breath sounds and is tympanic to percussion.
Explanation # 6
Trauma + distended veins in neck/head + deviated trachea + tympanic chest w/absent breath sounds = pneumothorax (tension)
Question # 7
A 67 year old male with a history of COPD is brought to the hospital with complaints of progressive dyspnea, a productive cough, and a fever for the past couple of days. An initial eval demonstrates that he is in respiratory distress. His temperature is 101.1°F, blood pressure is 125/75 mm Hg, pulse is 105/min, and respirations are 35/min. Pulse oximetry is 92% on 4L of oxygen by nasal cannula. He is suspected to have a OCPD exacerbation. He is intubated and put on mechanical ventilation. He also receives intravenous antibiotics, steroids, and inhaled bronchodilators. Despite these therapies the patient continues to desaturate over the next half hour, and his pulse oximetry reading lowers to a reading of 80% despite receiving 100% inspired oxygen. Repeat vitals show a blood pressure of 85/50 mm Hg, and pulse son 120/min. His trachea is deviated to the left, breath sounds are absent on the right side, and wheezes are heard on the left. His neck veins are visibly distended. What is the likely diagnosis in this patient.
Explanation # 7
Suspected barotrauma (ventilated patient) + distended veins in neck/head + deviated trachea + absent breath sounds = pneumothorax (tension)
Question # 8
A 38 year old woman is involved in a motor vehicle accident. When the EMS arrive she complains of shortness of breath and chest pain. Her vitals are a blood pressure of 60/to palpation, heart rate of 125, and respirations of 40/min. She has nostril flaring, sternal retractions, and is diaphoretic. Lung sounds are absent on the left. There is tracheal deviation to the right. Palpation of the right chest reveals the presence of crepitus and elicits pain the patient. There is also subcutaneous air in the left neck. What is the likely diagnosis?
Explanation # 8
Trauma + deviated trachea + absent breath sounds + crepitus = pneumothorax (tension)
Question # 9
Explanation # 9
TESTABLE FACTS ABOUT THIS TOPIC (BEYOND ITS IDENTIFICATION)
Many questions on standardized exams go beyond simply recognizing the underlying topic. Often there are specific testable facts regarding some aspect of the topic’s pathophysiology/management/clinical implications that are commonly asked. Some of these are listed below:
Page Updated: 11.19.2016