Term
| Which of the following statements regarding the thorax is correct? |
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Definition
| The diaphragm inserts into the anterior thoracic cage below the fifth rib |
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Term
| Bony structures of the thorax include all of the following, EXCEPT the: |
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Definition
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Term
| The eighth, ninth, and tenth ribs are indirectly attached to the sternum by the: |
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Definition
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Term
| The eleventh and twelfth ribs are known as the floating ribs because they: |
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Definition
| are not attached anteriorly to the sternum. |
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Term
| The space between the second and third ribs is called the: |
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Definition
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Term
| Which of the following is NOT a mediastinal structure? |
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Definition
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Term
| The visceral pericardial layer: |
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Definition
| adheres to the heart and forms the epicardium. |
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Term
| The anterior-most portion of the heart is the: |
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Definition
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Term
| The pressure within the right ventricle is: |
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Definition
| one fourth of the pressure within the left ventricle. |
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Term
| Most of the heart is protected: |
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Definition
| anteriorly by the sternum |
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Term
| What is the cardiac output for an 80-kg man who has a heart rate of 80 beats/min and a stroke volume of 60 mL? |
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Definition
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Term
| As soon as the aorta exits the left ventricle, it: |
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Definition
| ascends toward the right shoulder |
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Term
| Which of the following is NOT a sight of potential injury when the aorta is subjected to shearing forces during rapid deceleration? |
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Definition
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Term
| If the pleural space becomes filled with air or blood: |
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Definition
| surface tension is lost and the lung collapses. |
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Term
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Definition
| forms a barrier between the thoracic and abdominal cavities. |
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Term
| A flail chest is characterized by: |
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Definition
| a free-floating segment of fractured ribs |
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Term
| Isolated rib fractures may result in inadequate ventilation because: |
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Definition
| the patient often purposely limits chest wall movement. |
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Term
| Ribs 4 through 9 are the most commonly fractured because: |
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Definition
| they are less protected by other bony and muscular structures |
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Term
| The self-splinting effect observed in patients with chest wall trauma: |
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Definition
| may cause atelectasis, hypoxemia, or pneumonia. |
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Term
| Pneumothorax is MOST accurately defined as: |
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Definition
| air or gas within the pleural cavity. |
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Term
| An open pneumothorax causes ventilatory inadequacy when: |
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Definition
| negative pressure created by inspiration draws air into the pleural space |
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Term
| Pneumothoraces create a ventilation-perfusion mismatch when: |
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Definition
| perfusion of the involved lung continues while the pneumothorax prevents adequate ventilation. |
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Term
| What type of chest injury is characterized by air accumulation in the pleural space when a perforation in the lung parenchyma acts as a one-way valve? |
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Definition
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Term
| As air accumulates in the pleural space, the FIRST thing to occur is: |
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Definition
| decreased pulmonary function |
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Term
| Most hemothoraces occur when: |
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Definition
| a fractured rib injures the lung parenchyma. |
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Term
| By definition, a massive hemothorax is characterized by: |
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Definition
| more than 1,500 mL of blood within the pleural space. |
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Term
| A pulmonary contusion following blunt chest trauma results in: |
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Definition
| alveolar and capillary damage with intraparenchymal lung hemorrhage. |
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Term
| Which of the following statements regarding a pericardial tamponade is correct? |
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Definition
| n a pericardial tamponade, blood collects between the visceral and parietal pericardium. |
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Term
| Dysrhythmias following a myocardial contusion are usually secondary to: |
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Definition
| damage to myocardial tissue at the cellular level. |
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Term
| Commotio cordis is a phenomenon in which: |
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Definition
| ventricular fibrillation is induced following blunt trauma to the chest during the heart's repolarization period. |
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Term
| Traumatic injuries to the aorta are MOST commonly the result of: |
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Definition
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Term
| With the exception of the aorta, great vessel injury is MOST likely to occur following: |
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Definition
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Term
| Which of the following statements regarding diaphragmatic injury is correct? |
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Definition
| Because the diaphragm is protected by the liver on the right side, most diaphragmatic injuries caused by blunt force trauma occur on the left side. |
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Term
| Tracheobronchial injuries have a high mortality due to: |
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Definition
| associated airway obstruction. |
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Term
| Common clinical findings associated with a traumatic asphyxia include all of the following, EXCEPT: |
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Definition
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Term
| Which of the following clinical findings is MOST suggestive of inadequate oxygenation? |
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Definition
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Term
| Increased intravenous pressure commonly manifests as: |
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Definition
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Term
| Any patient with a presumptive diagnosis of a pneumothorax should: |
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Definition
| be considered unstable and reassessed every 5 minutes. |
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Term
| Which of the following thoracic injuries would you LEAST likely discover in the primary assessment? |
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Definition
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Term
| In general, patients suspected of having a partial tracheal tear should be managed with: |
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Definition
| the least invasive airway techniques possible |
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Term
| Which of the following thoracic injuries generally does NOT require immediate treatment? |
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Definition
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Term
| You would NOT expect a patient with a flail chest to present with |
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Definition
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Term
| Any normotensive patient with a sternal fracture should receive: |
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Definition
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Term
| A patient with a small simple pneumothorax would MOST likely present with diminished breath sounds: |
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Definition
| in the apices of the affected lung if he or she is sitting upright |
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Term
| Immediate treatment for an open pneumothorax involves: |
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Definition
| converting the pneumothorax to a closed injury. |
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Term
| Jugular venous distention during a tension pneumothorax: |
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Definition
| is caused by blood accumulation in the vena cava. |
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Term
| A blood pressure of 100/70 mm Hg in the presence of clinical signs of a tension pneumothorax: |
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Definition
| suggests adequate cardiac compensation for the diminished venous return. |
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Term
| Which of the following clinical signs may not be present in a patient with a tension pneumothorax and associated internal bleeding? |
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Definition
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Term
| The preferred site for performing a needle thoracentesis is: |
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Definition
| superior to the third rib into the intercostal space at the midclavicular line. |
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Term
| When performing a needle decompression of the chest, you should insert the needle: |
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Definition
| at a 90-degree angle and listen for the release of air. |
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Term
| Unlike a tension pneumothorax, a massive hemothorax would MOST likely present with: |
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Definition
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Term
| Due to intrapulmonary hemorrhage, patients with a pulmonary contusion may present with: |
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Definition
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Term
| You should be MOST suspicious that your patient has a pericardial tamponade if he or she presents with hypotension, jugular vein distention, and: |
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Definition
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Term
| Crackles or rales in the lungs following a myocardial contusion would MOST likely result from: |
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Definition
| left ventricular dysfunction |
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Term
| Most patients with an aortic injury will complain of pain: |
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Definition
| behind the sternum or in the scapula. |
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Term
| Management of a diaphragmatic injury focuses on: |
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Definition
| maintaining adequate oxygenation and ventilation, and rapid transport. |
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Term
| A 16-year-old man collapsed after being struck in the center of the chest by a line drive during a high school baseball game. Your assessment reveals that he is pulseless and apneic. As your partner initiates one-rescuer CPR, your MOST important action should be to: |
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Definition
| attach the ECG leads and be prepared to defibrillate. |
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Term
| You are assessing a 39-year-old man who experienced blunt chest trauma. He is semiconscious and has poor respiratory effort with stridor. You should: |
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Definition
| insert a nasal airway and assist ventilations with a bag-mask device. |
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Term
| A 50-year-old man was working on his car when the jacks collapsed and the car landed on his chest. Your assessment reveals profound cyanosis and swelling to his chest and face, agonal respirations, and a weak carotid pulse. This patient will benefit MOST from: |
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Definition
| aggressive airway management and rapid transport. |
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Term
| A 26-year-old unrestrained woman struck her chest on the steering wheel when her car collided with another vehicle. After performing your primary assessment and administering high-flow oxygen, you assess her chest and note a segment of obviously fractured ribs that bulges outward during exhalation. You should: |
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Definition
| apply a bulky dressing to the segment of fractured ribs. |
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Term
| A 30-year-old man felt a snap in his chest when he abruptly twisted his torso. He is conscious and alert, and complains of severe pain during inhalation. Your assessment reveals palpable tenderness over the fifth and sixth ribs on the left side. His vital signs are stable and he denies other injuries. In addition to administering supplemental oxygen, the MOST appropriate treatment for this patient involves: |
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Definition
| instructing the patient to hold a pillow against his chest, considering IV analgesics, and transporting to the hospital. |
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Term
| You are transporting a conscious and alert man who experienced an isolated blunt injury to the right anterolateral chest. His vital signs are stable, but he is dyspneic and his breath sounds are diminished over the apex of his right lung. In addition to administering high-flow oxygen, the MOST critical intervention for this patient involves: |
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Definition
| frequently reassessing him for signs of clinical deterioration |
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Term
| A convenience store clerk was stabbed during a robbery attempt. He is semiconscious with shallow breathing and weak radial pulses. During the rapid assessment, you find a single stab wound to his left anterior chest. His jugular veins are distended and his breath sounds are bilaterally diminished but equal. The MOST appropriate treatment for this patient involves: |
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Definition
| covering the stab wound with an occlusive dressing, assisting ventilations, transporting at once, and establishing large-bore IV lines en route |
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Term
| You are dispatched to a residence for an injured person. The scene has been secured by law. The patient, a young female, tells you that her boyfriend kicked her in the chest yesterday during an argument. Your assessment reveals that the patient is in significant pain, is dyspneic, has a strong heart rate of 98 beats/min, and has an area of ecchymosis over her left lower rib cage. Auscultation to the left side of her chest reveals coarse crackles. Which of the following treatment interventions is likely NOT indicated for this patient? |
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Definition
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Term
| A robbery suspect was shot once in the left anterior chest by law enforcement personnel when he pulled a gun on them. The patient is exhibiting obvious signs of shock, is in significant respiratory distress, and is coughing up blood. Further assessment reveals collapsed jugular veins and absent breath sounds over the left hemithorax. After covering the gunshot wound with the appropriate dressing, you should: |
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Definition
| provide oxygenation and ventilation support, transport at once, and maintain adequate perfusion with IV fluids while en route to a trauma center |
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Term
| Following blunt trauma to the anterior chest, a 44-year-old man presents with restlessness, respiratory distress, perioral cyanosis, and tachycardia. Further assessment reveals a midline trachea, engorged jugular veins, and absent breath sounds on the right side of his chest. You should: |
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Definition
| perform an immediate needle thoracentesis to the right side of the chest |
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