pneumothorax

[obiwan]

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does spontaneous pneumothorax always cause tracheal deviation to the ipsilateral side and tension pneumo. always cause deviation to contralateral side?

 

[It'sElectric]

I have no idea if they always do, but I'm pretty sure that's the line of thinking you should have. At least that's exactly how I'll approach any question I see on Step I. Goljan does a great job of explaining this on his audio.

 

[RxnMan]

I have no idea if they always do, but I'm pretty sure that's the line of thinking you should have. At least that's exactly how I'll approach any question I see on Step I. Goljan does a great job of explaining this on his audio.

What's that guy's name? Oh yes, George Clooney and that movie, "Three Kings"

Also remember that the wounds are different - tension will be a sucking chest wound -> pierced lung, diaghragm will be pushed down. A spontaneous one will have no external injury, diaphragm pushed up by vicera, MCC a pleural bleb (aka small congenital weakness in the lung), MC in tall skinny guys. Also: 9/10 times it's 'cause the kid was smoking pot.

 

[GynGuy1983]

What's that guy's name? Oh yes, George Clooney and that movie, "Three Kings"

Also remember that the wounds are different - tension will be a sucking chest wound -> pierced lung, diaghragm will be pushed down. A spontaneous one will have no external injury, diaphragm pushed up by vicera, MCC a pleural bleb (aka small congenital weakness in the lung), MC in tall skinny guys. Also: 9/10 times it's 'cause the kid was smoking pot.

Are you being factitious?

Also, the reference to the tall skinny guys can also allude to Marfan's syndrome, they also have a predisposition to spontaneous pneumothorax because of the abnormal fibrillin (i.e. abnormal elastic fibers, recoil forces, . . .).

 

[RxnMan]

Are you being factitious?
Also, the reference to the tall skinny guys can also allude to Marfan's syndrome, they also have a predisposition to spontaneous pneumothorax because of the abnormal fibrillin (i.e. abnormal elastic fibers, recoil forces, . . .).

Dead serious. Came from a private ICU doc I know who practices in suburbia. I've also been told it's on the EM board exams. Makes it easy to remember. If you don't believe me, think about this - what other activity is going to cause a greater pressure drop across the lung?

Yes, the "tall & skinny" description can also be applied to Marfans, but you're going to get a host of other features in the question (heart murmur, PHx of dislocated lens, pointy fingers, etc.) that'll point you towards Marfans.

All stems give you a CC which leads to a DDx. The rest of the question gives you HX + tests (both of which either eliminate some items on that DDx or make others more likely).

 

[GynGuy1983]

Dead serious. Came from a private ICU doc I know who practices in suburbia. I've also been told it's on the EM board exams. Makes it easy to remember. If you don't believe me, think about this - what other activity is going to cause a greater pressure drop across the lung?

Yes, the "tall & skinny" description can also be applied to Marfans, but you're going to get a host of other features in the question (heart murmur, PHx of dislocated lens, pointy fingers, etc.) that'll point you towards Marfans.

All stems give you a CC which leads to a DDx. The rest of the question gives you HX + tests (both of which either eliminate some items on that DDx or make others more likely).

Good point. I will be sure to remember that when I start my residency.

 

[TerpMD]

According to emedicine, spontaneous pneumo can convert to tension. So I would make sure to look at how sick the patient is in addition to the "tall lanky boy" factor. This concept is tested on NBME 4 though I will not give the details since we aren't supposed to post NBME qs 🙂

 

[obiwan]

According to emedicine, spontaneous pneumo can convert to tension. So I would make sure to look at how sick the patient is in addition to the "tall lanky boy" factor. This concept is tested on NBME 4 though I will not give the details since we aren't supposed to post NBME qs 🙂

Yeah, my question was referring to that question since none of the choices made sense.

 

[lord_jeebus]

Someone correct me if I'm wrong but I would not expect to see tracheal deviation in a primary spontaneous pneumothorax, unless it becomes a tension pneumothorax.

 

[MSKalltheway]

Yeah, my question was referring to that question since none of the choices made sense.

Ditto. TerpMD and I just had a convo about this, and the question only makes sense after you consider that spontaneous --> tension. I studied the hell out of the lung PE findings too, that really p*ssed me off 😡

 

[RxnMan]

According to emedicine, spontaneous pneumo can convert to tension. So I would make sure to look at how sick the patient is in addition to the "tall lanky boy" factor. This concept is tested on NBME 4 though I will not give the details since we aren't supposed to post NBME qs 🙂

Huh. I was taught they were two separate entities, but I kinda wondered how the collapsed lung in spontaneous never leaked air into the pleural space, i.e. didn't convert.

Makes sense, will watch for it come the real thing. Thanks. 👍

Yeah, my question was referring to that question since none of the choices made sense.

Sorry I didn't catch your meaning. I was more caught up on quoting Goljan.

Someone correct me if I'm wrong but I would not expect to see tracheal deviation in a primary spontaneous pneumothorax, unless it becomes a tension pneumothorax.

I thought the tracheal deviation, in either case, came from mass effect/pressure differences. In tension, trapped air -> inc. pressure -> pushes trachea away.

In spontaneous (if it hasn't converted!) the lung isn't inflated, there's less pressure on that side, the viscera pushes up and the trachea may deviate towards that side. Not as much as tension, but some.

This comes from a preclinical student who's never seen either!