Help with usmle style question

[jeshr108]

refurbished old post.

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[vicinihil]

I agree with you. I think in situations of spontaneous pneumothorax, the mediastinum should deviate toward it. This is opposed to an obj penetrating the chest wall into the cavity where the mediastinum then would shift to the opposite side (tension pneumothorax).

I may be missing something here though. Anyone else have an input?

 

[username456789]

It definitely should NOT be rupture of an apical bleb. That'd cause ipsilateral tracheal shift like vic said.

I would be inclined to go with your reasoning, as it seems plausible that a posterolateral hernia rupture would cause a compression atelectasis, among other things.

However, the way they set it up (healthy guy, 30 years old, sudden right shoulder pain) makes it REALLLLLY seem like they're fishing for the apical bleb rupture. Which leads me to believe they screwed up here.

 

[kryptik]

30yr old previously healthy male seems to be pointing to spontaneous pneumothorax, but the physicals points to tension pneumothorax, so i would go with option that causes tension pneuothorax which is the hernia. Also the right pain is referal of diaphragmatic pain.

 

[thechad]

30yr old previously healthy male seems to be pointing to spontaneous pneumothorax, but the physicals points to tension pneumothorax, so i would go with option that causes tension pneuothorax which is the hernia. Also the right pain is referal of diaphragmatic pain.

A hernia can cause tension pneumothorax? I haven't heard of that, are you sure?

 

[username456789]

A hernia can cause tension pneumothorax? I haven't heard of that, are you sure?

No. A tension ptx would cause the presentation we see here, but so would a hernia with rupture of abdominal contents into the thorax and compression of the lung.

However, that would not be considered a tension ptx.

 

[thechad]

No. A tension ptx would cause the presentation we see here, but so would a hernia with rupture of abdominal contents into the thorax and compression of the lung.

However, that would not be considered a tension ptx.

Well, a posterolateral hernia would be seen in an infant, so we can rule that out, since this guy is 30yo. An anterior hernia (which I guess is a hiatal hernia, right?), I don't think you would displace that much room in the thorax.

I think it's a crap question, but I could be wrong.

 

[username456789]

Well, a posterolateral hernia would be seen in an infant, so we can rule that out, since this guy is 30yo. An anterior hernia (which I guess is a hiatal hernia, right?), I don't think you would displace that much room in the thorax.

I think it's a crap question, but I could be wrong.

Not really sure, wasn't aware that posterolateral hernias were mostly in infants. A Google search would've turned that up for me.

It did, however, also return this:
http://www.informaworld.com/smpp/content~content=a787514556&db=all

Two cases of adult acute posterolateral herniation rupture. Unfortunately, I can't access the article itself. But it seems unlikely they'd be fishing for that.