View Answer

C

2. A patient undergoes a left scalene node biopsy to rule out carcinoma of the lung. One hour later, the patient is cyanotic and dyspneic; a marked tachycardia is accompanied by decreased breath sounds on the left. Which step is most likely to improve the patient's condition?

A Blood transfusion

B Insertion of a right subclavian catheter and administration of intravenous fluids

C Endotracheal intubation

D Insertion of a left chest tube

E Re-exploration of the wound

View Answer

D

3. A patient is brought to the emergency department with a stab wound to the right chest in the fourth intercostal space in the midaxillary line. The patient is hypotensive, complains of shortness of breath, and is found to have absent breath sounds on the right side of the chest. Which step should come next in the management of this patient?

A Chest radiograph

B Chest tube insertion

C Needle thoracentesis

D Local wound exploration

E Pericardiocentesis

View Answer

C

4. A tall, thin 19-year-old male presents to the emergency department with sudden onset of chest pain, cough, and shortness of breath. Breath sounds are absent in the left chest. Which of the following is an indication for surgery?

A Family history of recurrent spontaneous pneumothorax

B Persistent air leak after 3 days of chest tube drainage

C Identification of an apical bleb on chest CT

D Evidence of life-threatening respiratory compromise on initial presentation

E History of one prior episode successfully treated with conservative management on the contralateral side

View Answer

E

Questions 5–6

A chest radiograph of a 55-year-old man involved in a high-speed motor vehicle accident shows a widened mediastinum and pneumomediastinum. Electrocardiogram shows sinus tachycardia with frequent premature ventricular contractions.

5. All of the following maneuvers are appropriate at this time except

A Aortogram

B Bronchoscopy

C Continuous cardiac monitoring

D Left thoracotomy

E Endotracheal intubation

View Answer

D

6. Expected physiologic changes due to blunt chest trauma include all but which of the following?

A Elevated PCO₂

B Increased compliance

C Elevated A-a gradient

D Decreased ventricular contractions

E Elevated shunt fractions

View Answer

B

Questions 7–8

A 70-year-old patient on antibiotic therapy for necrotizing bacterial pneumonia is found to have a large pleural effusion.

7. In addition to continued antibiotics, what should be the next step in management of this patient?

A Sputum culture and sensitivity

B Chest tube insertion

C Thoracentesis

D Thoracotomy and decortication

E Rib resection and open drainage

View Answer

C

8. A sample of pleural fluid is cloudy and thick, with a pH of 7.2. What should be the next therapeutic step?

A Video-assisted thorascopic surgery with talc pleurodesis

B Chest tube drainage

C Repeat thoracentesis

D Thoracotomy and decortication

E Rib resection drainage

View Answer

B

9. A routine chest radiograph for a 55-year-old man with a 50 pack-year smoking history shows a peripherally located 1.5-cm, noncalcified lesion of the upper lobe of the left lung. No evidence of this lesion appeared on a chest radiograph 5 years earlier. What should be the next step in this patient's management?

A Observation with serial chest radiographs

B Thoracotomy

C Bronchoscopy

D Biopsy

E Sputum cytology