nbme 4 respiratory

[firstaid2012]

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1. a 19-year-old man is brought to the emergency department because of the sudden onset of sharp chest pain and difficulty breathing 3 hours ago. Temp is 37, pulse 110/min, respirations are 36/min and shallow. He is slightly cyanotic. Examination shows deviation of the trachea to the right and subcutaneous crepitus. Which of the follwing findings is the most likely in this patient?
a. Dullness of percussion on the right
b. hyperresonance of persussion of the left
c. Increased breath sounds on the left
d. Increased breath sounds on the right
e. Increased vocal fremitus on the left
f. Whispered pectoriloquy on the right


please explain

 

[firstaid2012]

anyone??

 

[thehundredthone]

Left sided spontaneous pneumothorax is the likely diagnosis, and so hyperresonance on the left side is the expected finding.

A young male with sudden onset chest pain is usually pneumothorax due to rupture of blebs.

Increased breath sounds are usually not described. Harsh vesicular and bronchial perhaps, but not increased.

Increased vocal fremitus and whispering pectoriloquy are signs of consolidation, usually pneumonia.

Dullness of percussion on the right is possible if this were a case of atelectasis but the subcutaneous crepitus goes against that.

 

[firstaid2012]

i think i have a confusion about this concept i thought that in spontaneous that the trachea deviates towards the side of the lesion so then shudnt the hypersonace be on the right too? am i missing something big here? thank you for your help

 

[thehundredthone]

I remember reading discussions about tracheal deviation in pneumothorax. But given the answer choices, the best answer is B. There isn't any option that favours the ipsilateral deviation theory, and I believe it's not set in stone, so it's best to go with the workflow of pneumothorax -> trachea pushed to opposite side. I'm sure it can be argued to death, but I won't be participating.

Here:
http://forums.studentdoctor.net/showthread.php?t=633411

 

[firstaid2012]

thank you🙂 its ok il just go with what you said exam in 3 days🙁