10+122(2)

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Carrington College, Las Vegas *

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121

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Biology

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Jan 9, 2024

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10 Multiple Choice Identify the choice that best completes the statement or answers the question. ____ 1. Which of the following are anatomic alterations that occur when a person has a pneumothorax? 1. The lung on the affected side collapses. 2. The visceral and parietal pleura separate. 3. The visceral pleura adheres to the parietal pleura. 4. The chest wall moves outward. a. 1, 3 b. 3, 4 c. 2, 4 d. 1, 2, 4 ____ 2. A pneumothorax manifests itself clinically as a primary _____ disorder. a. restrictive b. obstructive c. restrictive disorder with a secondary obstructive d. obstructive disorder with secondary restrictive ____ 3. What is the primary cause of hypotension in a patient with a large pneumothorax? a. Pain b. Decreased venous return to the heart c. Tracheal compression d. Atelectasis ____ 4. According to the way gas enters the pleural space, a pneumothorax will be classified as: 1. intrinsic. 2. extrinsic. 3. open. 4. closed. a. 2, 3 b. 1, 4 c. 3, 4 d. 1, 2 ____ 5. A patient had a penetrating knife wound to her chest wall that resulted in a valvular pneumothorax. What is another term for this condition? a. Spontaneous pneumothorax b. Tension pneumothorax c. Iatrogenic pneumothorax d. Benign pneumothorax ____ 6. A 17-year-old male has been brought to the hospital because he felt short of breath after being tackled in a football game. A chest radiograph shows a broken rib and a pneumothorax in the right lung with pleural space not in direct contact with the atmosphere. Which of the following conditions would be present?

a. Closed pneumothorax b. Pleural effusion c. Iatrogenic pneumothorax d. Sucking chest wound ____ 7. A 6-foot-tall, 140-pound, 28-year-old female patient has come to the emergency department with a complaint of a sudden sharp pain in the right upper chest followed by shortness of breath. The pain originated while she participated in deep breathing exercises in a yoga class. The physician has determined that she has a 15% pneumothorax. How should the pneumothorax be classified? a. Open b. Exercise related c. Spontaneous d. Traumatic ____ 8. An iatrogenic pneumothorax may be caused by: 1. positive-pressure mechanical ventilation. 2. pleural biopsy 3. subclavian vein cannulation. 4. endotracheal intubation. a. 1, 3 b. 1, 2, 4 c. 2, 3, 4 d. 1, 2, 3 ____ 9. A 40-year-old patient requires placement of a thoracostomy chest tube. Which of the following are recommended for the procedure? 1. Application of –5 cm H 2 O pressure to the chest tube 2. Use of a No. 28 to 36 French gauge tube 3. Placement of the tube at the apex of the lung 4. Clamping and removing the tube within 24 hours of insertion a. 1, 3 b. 1, 2, 4 c. 2, 3, 4 d. 1, 2, 3 ____ 10. After a patient experienced four pneumothoraces of her right lung over a 24-month period, the physician recommended a procedure to reduce the occurrence of future pneumothoraces. Which procedure would the physician have recommended? a. Pleurodesis b. Right pneumonectomy c. Permanent right-sided thoracostomy tube d. Right upper lobectomy ____ 11. A patient has a pneumothorax with a sucking chest wound resulting in the movement of gas from one lung to another. This is called: a. panting. b. paradoxical movement. c. bidirectional flow.

d. pendelluft. ____ 12. Which of the following chest assessment findings would be expected in a patient with a tension pneumothorax? a. Decreased thoracic volume on the affected side b. Dull percussion note c. Tracheal shift away from the affected side d. Wheezes ____ 13. Which of the following hemodynamic indices will be found in a patient with a large hemothorax? a. Decreased Q S /Q T b. Decreased CO c. Increased CI d. Increased SV ____ 14. If the patient has a tension pneumothorax, which of the following chest radiograph findings would be expected? 1. Elevated diaphragm 2. Mediastinal shift to the unaffected side 3. Increased translucency on the side of the pneumothorax 4. Atelectasis a. 1, 3 b. 1, 2, 4 c. 2, 3, 4 d. 1, 2, 3 ____ 15. A sucking chest wound would be classified as a(n) _____ pneumothorax. a. open b. closed c. iatrogenic d. valvular ____ 16. Which type of pneumothorax would result from the rupture of bulla on the surface of a lung? a. Spontaneous pneumothorax b. Iatrogenic pneumothorax c. Open pneumothorax d. Visceral pneumothorax ____ 17. Which type of untreated pneumothorax is considered to be the most serious? a. Spontaneous b. Tension c. Malignant d. Iatrogenic ____ 18. Gas can gain entrance to the pleural space: 1. via the lungs through a perforation of the visceral pleura. 2. via the surrounding atmosphere through a perforation of the chest wall and parietal pleura. 3. from gas-forming microorganisms in an empyema in the pleural space. 4. from a pulmonary embolism in the pulmonary artery.

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a. 1, 3 b. 1, 2, 4 c. 2, 3, 4 d. 1, 2, 3 ____ 19. The anatomic alteration caused by a pleural effusion is: a. pulmonary fibrosis. b. separation of the visceral and parietal pleura. c. adhesion of the visceral and parietal pleura. d. pulmonary edema. ____ 20. The major pathologic and structural changes associated with a significant pleural effusion include which of the following? 1. Diaphragm elevation 2. Atelectasis 3. Compression of the great vessels 4. Lung compression a. 1, 4 b. 2, 3 c. 2, 3, 4 d. 1, 3, 4 ____ 21. Which of the following are associated with a transudative pleural effusion? 1. Thin and watery fluid 2. Fluid has a lot of cellular debris 3. Fluid has high protein count 4. Few blood cells a. 2, 3 b. 1, 4 c. 1, 2, 3 d. 1, 3, 4 ____ 22. A patient has malignant mesothelioma related to chronic asbestos exposure. What would his pleural effusion fluid likely show on laboratory analysis? 1. Erythrocytes 2. Lymphocytes 3. Normal mesothelial cells 4. Malignant mesothelial cells a. 1, 4 b. 2, 3 c. 2, 3, 4 d. 1, 2, 4 ____ 23. An adult patient with a large pleural effusion requires placement of a thoracostomy tube. Which of the following statements are true regarding thoracostomy tube placement? 1. The tube is placed in the second to third intercostal space. 2. The tube is placed in the fourth to fifth intercostal space. 3. The tube is placed in the midclavicular line.

4. The tube is placed in the midaxillary line. a. 1, 4 b. 2, 3 c. 1, 3 d. 2, 4 ____ 24. Treatment of an empyema typically includes: a. pleurodesis. b. thoracostomy tube insertion. c. lobectomy. d. pneumonectomy. ____ 25. A patient has a pleural effusion from an unknown cause. A fluid sample has been taken for analysis. To help identify the cause of the effusion, which of the following tests should be performed? 1. Specific gravity 2. Biochemical makeup 3. Cytologic examination 4. Bacterial culture a. 1, 3 b. 1, 2, 4 c. 2, 3, 4 d. 1, 2, 3 ____ 26. A respiratory therapist is assisting a physician who is performing a thoracentesis. It is suspected that the patient has a chylothorax. How would the pleural effusion be described? a. Milky white b. Straw colored c. Red d. Green ____ 27. During a chest assessment on a patient with a large pleural effusion, which of the following would be expected? 1. Increased tactile and vocal fremitus 2. Hyperresonant percussion note 3. Diminished breath sounds 4. Tracheal shift a. 1, 4 b. 1, 2 c. 3, 4 d. 1, 3, 4 ____ 28. While reviewing an upright chest radiograph of a patient with a pleural effusion, the respiratory therapist observes a fluid density in the right lung area that extends upward around the anterior, lateral, and posterior thoracic walls. What is this characteristic sign called? a. Meniscus sign b. Scarf sign c. Transudate sign d. Kerley B lines

____ 29. Which of the following are chest radiograph findings associated with a large pleural effusion? 1. Blunting of the costophrenic angle 2. Fluid level on the affected side 3. Mediastinal shift toward the unaffected side 4. Elevated hemidiaphragm on the affected side a. 1, 3 b. 2, 4 c. 1, 2, 4 d. 1, 2, 3 ____ 30. What percentage of patients with bacterial pneumonia are likely to develop pleural effusion? a. Up to 10% b. Up to 20% c. Up to 30% d. Up to 40% ____ 31. In the absence of surgery or trauma, what does the presence of blood in the pleural fluid most likely signify? a. Malignant disease b. Fungal disease c. Chylothorax d. Tuberculosis ____ 32. What is the most common cause of a chylothorax? a. Thoracic duct trauma b. Abdominal tumor c. GERD d. Pyloric stenosis ____ 33. Pulmonary function testing on a patient with atelectasis associated with pleural effusion would likely reveal: 1. increased VC. 2. decreased ERV. 3. decreased FRC. 4. normal RV/TLC ratio. a. 1, 4 b. 2, 3 c. 2, 3, 4 d. 1, 3, 4

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10 Answer Section MULTIPLE CHOICE 1. ANS: D When air is introduced between the visceral and parietal pleura, the pleura will separate, leading to lung collapse and the outward movement of the chest wall. PTS: 1 2. ANS: A A pneumothorax manifests itself clinically as a restrictive pulmonary disorder because air in the pleural space limits inspiration. In a tension pneumothorax, the heart may be pushed away from the affected lung. Although this can decrease cardiac output, a pneumothorax directly affects lung function. PTS: 1 3. ANS: B A pneumothorax can cause compression of the great vessels and decrease venous return to the heart. PTS: 1 4. ANS: C No matter how air enters the pleural space, a pneumothorax will be classified as open or closed. PTS: 1 5. ANS: B A valvular pneumothorax is also called a tension pneumothorax . Gas enters the pleural space on inspiration but cannot exit due to the valvelike action of the pleura or chest wall itself. PTS: 1 6. ANS: A If the pneumothorax is the result of an internal lung injury (in this case probably from the sharp edge of the broken rib), it is called a closed pneumothorax . In a closed pneumothorax, gas in the pleural space is not in direct contact with the atmosphere. PTS: 1 7. ANS: C When a pneumothorax occurs suddenly and without any obvious underlying cause, it is referred to as a spontaneous pneumothorax. A spontaneous pneumothorax is secondary to certain underlying pathologic processes such as pneumonia, tuberculosis, and chronic obstructive pulmonary disease (COPD). A spontaneous pneumothorax is sometimes caused by the rupture of a small bleb or bulla on the surface of the lung. PTS: 1 8. ANS: D Endotracheal intubation does not pose a risk for pneumothorax. All of the other listed options can lead to medical procedure–related pneumothorax.

PTS: 1 9. ANS: D Thoracostomy tubes are clamped only after bubbling from the tube has ceased and then are left in place without suction for another 24 to 48 hours. PTS: 1 10. ANS: A A pleurodesis involves placement of chemical or pharmacologic agents into the chest cavity to cause an inflammatory reaction to increase the adherence of the pleural surface to the inside of the chest wall. The procedure reduces the occurrence of future pneumothoraces. PTS: 1 11. ANS: D Pendelluft is the movement of gas from one lung to another. PTS: 1 12. ANS: C With a tension pneumothorax, the buildup of air pressure on the affected side of the chest pushes the trachea, lung, and heart to the opposite (unaffected) side. PTS: 1 13. ANS: B Because a large pneumothorax can impede venous blood return to the heart, the cardiac output (CO) will be decreased. PTS: 1 14. ANS: C The buildup of air in the pleural space will depress rather than elevate the diaphragm. PTS: 1 15. ANS: A A sucking chest wound is an example of an open pneumothorax. PTS: 1 16. ANS: A When blebs or bulla on the surface of the lung suddenly rupture, the pneumothorax that results is termed a spontaneous pneumothorax . PTS: 1 17. ANS: B An untreated tension pneumothorax is considered the most serious type of pneumothorax due to the compression of the affected lung and mediastinum. PTS: 1 18. ANS: D Gas can gain entrance to the pleural space in the following three ways: 1. From the lungs through a perforation of the visceral pleura.

2. From the surrounding atmosphere through a perforation of the chest wall and parietal pleura or, rarely, through an esophageal fistula or a perforated abdominal viscus. 3. From gas-forming microorganisms in an empyema in the pleural space (rare). PTS: 1 19. ANS: B A number of pleural diseases can cause fluid to accumulate in the pleural space; this fluid is called a pleural effusion. Similar to free air in the pleural space, fluid accumulation separates the visceral and parietal pleura and compresses the lungs. PTS: 1 20. ANS: C A large effusion could cause the diaphragm to be depressed, not elevated. PTS: 1 21. ANS: B A transudative pleural effusion is thin and watery with few blood cells, little cellular debris, and a low protein count. PTS: 1 22. ANS: C Asbestos is known to cause mesothelioma, a cancer of the mesothelial cells lining the lungs and chest wall (the visceral and parietal pleura). The pleural effusion fluid, in this case, will show a mix of normal and abnormal mesothelial cells and lymphocytes. PTS: 1 23. ANS: D Because fluid pools at the base of the lung, the chest tube is placed in the fourth to fifth intercostal space in the midaxillary line. PTS: 1 24. ANS: B The treatment of an empyema may require placement of a thoracostomy tube. PTS: 1 25. ANS: C Specific gravity is a measurement of the density of fluids and would not be indicated in evaluating the cause of a pleural effusion. PTS: 1 26. ANS: C In a chylothorax, the fluid in the pleural cavity would appear to be milky white. PTS: 1 27. ANS: C A tracheal shift and diminished breath sounds are findings consistent with a large pleural effusion. PTS: 1

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28. ANS: A In a moderate pleural effusion (>1000 mL) in the upright position, an increased density usually appears at the costophrenic angle. The fluid first accumulates posteriorly in the most dependent part of the thoracic cavity between the inferior surface of the lower lobe and the diaphragm. As the fluid volume increases, it extends upward around the anterior, lateral, and posterior thoracic walls in the so-called meniscus sign. PTS: 1 29. ANS: D Typical radiographic findings in a large pleural effusion include blunting of the costophrenic angle, fluid level on the affected side, and mediastinal shift to the unaffected side. PTS: 1 30. ANS: D As many as 40% of patients with bacterial pneumonia have an accompanying pleural effusion. PTS: 1 31. ANS: A In the absence of trauma or surgery, blood in the pleural fluid most likely results from malignant disease. A pulmonary embolization and infarction may also cause blood in the pleural fluid. PTS: 1 32. ANS: A When the thoracic duct is damaged by trauma, a chylothorax can result. Thoracic duct trauma is the most common cause of a chylothorax. PTS: 1 33. ANS: C Pulmonary Function Test Findings (Restrictive Lung Pathology) Lung Volume and Capacity Findings on a patient with atelectasis associated with pleural effusion V T IRV ERV RV N or VC IC FRC TLC RV/TLC ratio N PTS: 1

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