Question 1

A flail chest is defined as:&#10;1) one fractured rib or two adjacent fractured ribs.&#10;2) three or more adjacent fractured ribs.&#10;3) single rib fractures.&#10;4) double rib fractures.&#10;A)2&#10;B)2, 3&#10;C)1, 3&#10;D)2, 4

Accepted Answer

2, 4

Question 2

While assessing a patient who was involved in a serious car crash and hit his steering wheel, you notice that his left anterior chest wall caves in during inspiration. What could cause this?&#10;A) Singultus&#10;B)Flail chest segment&#10;C)Pneumothorax&#10;D)Cardiac tamponade

Accepted Answer

A flail chest segment is when two or more ribs are broken in two or more places, creating a segment of the chest wall that moves paradoxically during breathing. This can cause caving in during inspiration. Singultus (hiccups) and cardiac tamponade do not typically cause chest wall abnormalities during breathing. Pneumothorax can cause a collapsed lung but may not necessarily result in a caving chest wall.

Question 3

When a patient has a flail chest, what happens during the ventilatory cycle?&#10;A) The I:E ratio becomes inverse.&#10;B)Air leaks out through the flail area.&#10;C)Air leaks in through the flail area.&#10;D)Air is shunted from one lung to the other.

Accepted Answer

Air is shunted from one lung to the other.

Question 4

Major pathologic and structural changes associated with a flail chest include:
1) pneumothorax.
2) secondary pneumonia.
3) pleural effusion.
4) elevated diaphragms.

A)1, 2
B)3, 4
C)1, 3, 4
D)1, 2, 3, 4

Accepted Answer

Flail chest is often associated with pneumothorax due to rib fractures and can lead to secondary pneumonia due to impaired ventilation and secretion clearance.

Question 5

The major anatomic alterations of the lungs associated with flail chest include:
1) hemothorax.
2) diaphragm rupture.
3) atelectasis.
4) consolidation.

A)1,2
B)3, 4
C)1, 2, 3
D)2, 3, 4

Accepted Answer

Flail chest can lead to atelectasis due to impaired ventilation and consolidation due to lung contusion or infection. Hemothorax and diaphragm rupture are not directly associated with flail chest.

Question 6

Causes of a flail chest include all of the following EXCEPT:&#10;A) blast injury.&#10;B)motor vehicle accident.&#10;C)split sternum for open heart surgery.&#10;D)fall from high altitude.

Accepted Answer

A split sternum for open heart surgery would not cause a flail chest, as the ribs would not be affected. The other choices can cause a flail chest, as they involve trauma to the chest and ribcage.

Question 7

What is a possible lung finding under the fractured ribs of a flail chest?&#10;A) Contusion&#10;B)Abscess&#10;C)Bronchospasm&#10;D)Fibrosis

Accepted Answer

A flail chest is a medical condition in which a segment of the chest wall is detached from the chest wall and moves independently during breathing. Fractured ribs are a common cause of flail chest. Lung contusion is a common finding in flail chest because the detached chest wall segment may cause injury to the underlying lung tissue. Abscess, bronchospasm, and fibrosis are unlikely to be found in a flail chest.

Question 8

Your patient with a flail chest is experiencing pendelluft. What are its effects?
1) Hypoventilation
2) Hypertension
3) Cyclical deeper and then more shallow breathing
4) Rebreathing dead-space gas

A)1, 4
B)1, 3
C)2, 3, 4
D)1, 2, 3, 4

Accepted Answer

Pendelluft causes hypoventilation due to inefficient gas exchange and rebreathing of dead-space gas as air moves between lung regions instead of out of the body.

Question 9

If mechanical ventilation is required, how long will it be needed to allow sufficient time for bone healing?&#10;A) up to 5 days&#10;B)5 to 10 days&#10;C)10 to15 days&#10;D)greater than 15 days for full bone healing

Accepted Answer

The answer of If mechanical ventilation is required, how long...

Question 10

Your flail chest patient requires supplemental oxygen. What is the usual cause of hypoxemia in a flail chest patient?&#10;A) Myocardial contusion&#10;B)Hemorrhage&#10;C)Pulmonary edema&#10;D)Alveolar atelectasis

Accepted Answer

The usual cause of hypoxemia in a flail chest patient is alveolar atelectasis, which occurs because of the inability of the chest wall to expand adequately, resulting in decreased ventilation and inadequate oxygenation. This happens due to the paradoxical movement of the chest wall during breathing, which impairs the normal physiology of respiration. Both A (myocardial contusion) and B (hemorrhage) can lead to hypoxemia, but they are not the primary cause in flail chest patients. Pulmonary edema is not a common complication in a flail chest patient.

Question 11

In severe cases of flail chest, all of the following will usually be needed:
1) Continuous positive airway pressure (CPAP)
2) Pain management
3) Mechanical ventilation
4) Positive end-expiratory pressure (PEEP)

A)1, 2
B)2, 4
C)2, 3, 4
D)1, 2, 3, 4

Accepted Answer

The answer of In severe cases of flail chest, all...

Question 12

Your patient with a flail chest has paradoxical chest movement. What would be seen with this?&#10;A) With an inspiration, the fractured ribs move outward.&#10;B)The trachea deviates away from the flail side of the chest.&#10;C)During inspiration, the fractured ribs move inward.&#10;D)During exhalation, the flail area moves inward.

Accepted Answer

The answer of Your patient with a flail chest has...

Question 13

While assessing your patient with flail chest, you would expect to hear what kind of breath sounds?&#10;A) Diminished over the flail chest lung&#10;B)Diminished over both lungs&#10;C)Crackles over the flail chest lung&#10;D)Bilateral wheezing

Accepted Answer

The answer of While assessing your patient with flail chest,...

Question 14

What chest radiograph findings would be expected on a patient with a flail chest?
1) Decreased opacity
2) Rib fractures
3) Increased opacity
4) Tracheal narrowing or deviation

A)2
B)1, 4
C)2, 3
D)2, 3, 4

Accepted Answer

The answer of What chest radiograph findings would be expected...

Question 15

Your patient with a flail chest has developed consolidation. What should be implemented to help manage it?&#10;A) Hyperinflation therapy protocol&#10;B)Antibiotics&#10;C)Mechanical ventilation protocol&#10;D)Oxygen therapy protocol

Accepted Answer

The answer of Your patient with a flail chest has...

Deck 21: Flail Chest